MEDICARE: SHANILLE CLARKE DAVIS COTA, RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	1116933	TX
2	163WP0200X	Pediatric Registered Nurse	1116933	TX
3	224Z00000X	Occupational Therapy Assistant	214385	TX
4	251B00000X	Case Management Agency	1116933	TX
5	171M00000X	Case Manager/Care Coordinator	1116933	TX

General Provider Information

NPI Number	:	1831670728
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANILLE CLARKE DAVIS COTA, RN

Provider Business Mailing Address
First Line	:	20018 SILVER MESIA CIR
Second Line	:
City	:	CYPRESS
State	:	TX
Zip	:	77433-6805
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	20018 SILVER MESIA CIR
Second Line	:
City	:	CYPRESS
State	:	TX
Zip	:	77433-6805
Country	:	US
Telephone Number	:	954-608-5636
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/28/2018
Last Update Date	:	05/27/2025

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