Healthcare Provider Details

I. General information

NPI: 1447946751
Provider Name (Legal Business Name): SHAYNA PETERZELL DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2023
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 WISCONSIN AVE NW STE 4
WASHINGTON DC
20016-2143
US

IV. Provider business mailing address

4200 WISCONSIN AVE NW STE 200
WASHINGTON DC
20016-2101
US

V. Phone/Fax

Practice location:
  • Phone: 202-243-3400
  • Fax:
Mailing address:
  • Phone: 202-451-6759
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number600005921
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: