MEDICARE: SHIRLEY GRAY RN

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	163WX0106X	Occupational Health Registered Nurse	R124159	MD

General Provider Information

NPI Number	:	1255574133
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHIRLEY GRAY RN

Provider Business Mailing Address
First Line	:	6940 CARROLL AVE
Second Line	:
City	:	TAKOMA PARK
State	:	MD
Zip	:	20912-4432
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1325 EAST WEST HWY
Second Line	:	SSMC2 RM 9300
City	:	SILVER SPRING
State	:	MD
Zip	:	20910
Country	:	US
Telephone Number	:	301-713-0545
Fax Number	:	301-713-0379

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

Provider Enumeration Date	:	04/08/2009
Last Update Date	:	04/08/2009

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