Provider Demographics
NPI:1750035531
Name:HILL, SCHAMONA LAKEASHA
Entity Type:Individual
Prefix:
First Name:SCHAMONA
Middle Name:LAKEASHA
Last Name:HILL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4282 CYNTHIA TER
Mailing Address - Street 2:
Mailing Address - City:NORTH PORT
Mailing Address - State:FL
Mailing Address - Zip Code:34286-7632
Mailing Address - Country:US
Mailing Address - Phone:941-268-5437
Mailing Address - Fax:
Practice Address - Street 1:4282 CYNTHIA TER
Practice Address - Street 2:
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34286-7632
Practice Address - Country:US
Practice Address - Phone:941-268-5437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-09
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL679886196Medicaid