Healthcare Provider Details

I. General information

NPI: 1730008350
Provider Name (Legal Business Name): SHAVONNE CAMPBELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2124 MARTIN LUTHER KING JR AVE SE
WASHINGTON DC
20020-5732
US

IV. Provider business mailing address

612 MELLON ST SE APT 102
WASHINGTON DC
20032-2540
US

V. Phone/Fax

Practice location:
  • Phone: 202-253-1558
  • Fax:
Mailing address:
  • Phone: 202-253-1558
  • 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: