MEDICARE: SHAVON MONIQUE JENNINGS

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	374U00000X	Home Health Aide

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922738202
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAVON MONIQUE JENNINGS

Provider Business Mailing Address
First Line	:	3618 CUMMINGS RD
Second Line	:
City	:	CLEVELAND HTS
State	:	OH
Zip	:	44118-2627
Country	:	US
Telephone Number	:	216-512-3691
Fax Number	:

Provider Business Practice Location Address
First Line	:	3047 E 121ST ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44120-2965
Country	:	US
Telephone Number	:	216-203-7009
Fax Number	:

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

Provider Enumeration Date	:	06/10/2022
Last Update Date	:	06/10/2022

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Directions to “ SHAVON MONIQUE JENNINGS ” Practice Location

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