MEDICARE: CHILDREN'S HEART INSTITUTE

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	2080P0202X	Pediatric Cardiology Physician

General Provider Information

NPI Number	:	1063389807
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHILDREN'S HEART INSTITUTE

Provider Business Mailing Address
First Line	:	171 ELDEN ST STE 2C4
Second Line	:
City	:	HERNDON
State	:	VA
Zip	:	20170-4875
Country	:	US
Telephone Number	:	571-612-2600
Fax Number	:	571-266-4096

Provider Business Practice Location Address
First Line	:	97 THOMAS JOHNSON DR STE 202
Second Line	:
City	:	FREDERICK
State	:	MD
Zip	:	21702-4374
Country	:	US
Telephone Number	:	571-612-2600
Fax Number	:	571-266-4096

Authorized Official
Title or Position	:	PRACTICE ADMIN
Name	:	KRISTIE BUTLER-SHUTTS
Credential	:
Telephone Number	:	571-612-2600

Provider Enumeration Date	:	10/17/2025
Last Update Date	:	10/17/2025

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Directions to “CHILDREN'S HEART INSTITUTE ” Practice Location

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