Healthcare Provider Details

I. General information

NPI: 1396253993
Provider Name (Legal Business Name): SHARON MARIE MCDUFFIE RN, CEE, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2018
Last Update Date: 01/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 IRVING ST NW
WASHINGTON DC
20010-3017
US

IV. Provider business mailing address

6427 FAIRBORN TERRACE
NEW CARROLLTON MD
20784
US

V. Phone/Fax

Practice location:
  • Phone: 202-877-2897
  • Fax:
Mailing address:
  • Phone: 240-515-8740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number41806
License Number StateZZ
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN61210
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: