Shanique Ebanks, is a medicare enrolled "Social Worker - Clinical" provider in Fort Lauderdale, Florida. Her current practice location is
2900 W Prospect Rd, Fort Lauderdale, Florida. You can reach out to her office (for appointments etc.) via phone at
(954) 731-5100.
Shanique Ebanks is licensed to practice in Florida (license number SW14586) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1578937918.
Healthcare Provider's Profile
| Full Name | Shanique Ebanks |
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| Gender | Female |
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| Speciality | Social Worker - Clinical |
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| Location | 2900 W Prospect Rd, Fort Lauderdale, Florida |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1578937918
- Provider Enumeration Date: 11/23/2015
- Last Update Date: 10/08/2018
Medicare PECOS Information:
- PECOS PAC ID: 3870820798
- Enrollment ID: I20190814002991
Medical Identifiers
Medical identifiers for Shanique Ebanks such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1578937918 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 101YM0800X | Counselor - Mental Health | SW14586 (Florida) | Secondary |
| 104100000X | Social Worker | (* (Not Available)) | Secondary |
| 1041C0700X | Social Worker - Clinical | SW14586 (Florida) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Shanique Ebanks allows following entities to bill medicare on her behalf.
| Entity Name | Blue Moon Senior Counseling |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1205129186
PECOS PAC ID: 6103099759
Enrollment ID: O20111027000391 |
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| Entity Name | Mtca Psychological Services P.a. |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1740552322
PECOS PAC ID: 6406010834
Enrollment ID: O20120614000204 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Shanique Ebanks is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Shanique Ebanks,
4740 N State Road 7,
Lauderdale Lakes, FL 33319-5839
Ph: (954) 486-4005 | Shanique Ebanks,
2900 W Prospect Rd,
Fort Lauderdale, FL 33309-2519
Ph: (954) 731-5100 |
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