Healthcare Provider Details

I. General information

NPI: 1063714327
Provider Name (Legal Business Name): SHAMARA DENISE LONG MSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2010
Last Update Date: 07/28/2022
Certification Date: 07/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021 K ST NW STE 701
WASHINGTON DC
20006-1054
US

IV. Provider business mailing address

11609 NEON RD
FORT WASHINGTON MD
20744-5152
US

V. Phone/Fax

Practice location:
  • Phone: 301-664-2148
  • Fax:
Mailing address:
  • Phone: 202-860-4888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173C00000X
TaxonomyReflexologist
License NumberMT004968
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT004968
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code364SW0102X
TaxonomyWomen's Health Clinical Nurse Specialist
License NumberRN1052788
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: