MEDICARE: XIKERRIYAH E SHANKS

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251E00000X	Home Health Agency
2	372600000X	Adult Companion
3	376J00000X	Homemaker

General Provider Information

NPI Number	:	1891415246
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	XIKERRIYAH E SHANKS

Provider Business Mailing Address
First Line	:	6710 COLLINS RD APT 705
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32244-5876
Country	:	US
Telephone Number	:	904-403-5992
Fax Number	:

Provider Business Practice Location Address
First Line	:	6710 COLLINS RD APT 705
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32244-5876
Country	:	US
Telephone Number	:	904-403-5992
Fax Number	:

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

Provider Enumeration Date	:	08/29/2022
Last Update Date	:	12/27/2022

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Directions to “ XIKERRIYAH E SHANKS ” Practice Location

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