MEDICARE: SHANIQUE HARRIS

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	172A00000X	Driver
2	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1992564215
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANIQUE HARRIS

Provider Business Mailing Address
First Line	:	1428 TECUMSEH ST
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43607-4353
Country	:	US
Telephone Number	:	419-807-6153
Fax Number	:

Provider Business Practice Location Address
First Line	:	1428 TECUMSEH ST
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43607-4353
Country	:	US
Telephone Number	:	419-807-6153
Fax Number	:

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

Provider Enumeration Date	:	03/18/2024
Last Update Date	:	03/18/2024

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Directions to “ SHANIQUE HARRIS ” Practice Location

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