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NPI Code Detail

MEDICARE: SHANELL ASHLEY JORDAN

MEDICARE: SHANELL ASHLEY JORDAN
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
1171M00000XCase Manager/Care CoordinatorDC

General Provider Information

NPI Number : 1801759691
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANELL ASHLEY JORDAN
Provider Business Mailing Address
First Line : 200 K ST NE APT 1140
Second Line :
City : WASHINGTON
State : DC
Zip : 20002-3094
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1301 LENFANT SQ SE
Second Line :
City : WASHINGTON
State : DC
Zip : 20020-6724
Country : US
Telephone Number : 202-422-4886
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/08/2025
Last Update Date : 12/08/2025

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Directions to “ SHANELL ASHLEY JORDAN ” Practice Location

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