MEDICARE: DR. SHAMEKA NICOLE JOHNSON PH.D.

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	235Z00000X	Speech-Language Pathologist	000290	DC

General Provider Information

NPI Number	:	1306212857
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHAMEKA NICOLE JOHNSON PH.D.

Provider Business Mailing Address
First Line	:	1203 FIDLER LN
Second Line	:	APT. 1213
City	:	SILVER SPRING
State	:	MD
Zip	:	20910-3490
Country	:	US
Telephone Number	:	609-568-0358
Fax Number	:

Provider Business Practice Location Address
First Line	:	1203 FIDLER LN
Second Line	:	APT. 1213
City	:	SILVER SPRING
State	:	MD
Zip	:	20910-3490
Country	:	US
Telephone Number	:	609-568-0358
Fax Number	:

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

Provider Enumeration Date	:	08/19/2015
Last Update Date	:	08/19/2015

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