Healthcare Provider Details

I. General information

NPI: 1285562074
Provider Name (Legal Business Name): SHADARYL JONES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1418 MARION BARRY AVE SE
WASHINGTON DC
20020-5615
US

IV. Provider business mailing address

119 ALBANY PL
UPPER MARLBORO MD
20774-1070
US

V. Phone/Fax

Practice location:
  • Phone: 202-796-5000
  • Fax:
Mailing address:
  • Phone: 202-422-7307
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: