Healthcare Provider Details

I. General information

NPI: 1609608074
Provider Name (Legal Business Name): SHAY NICHOLE BOWIE RCP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2024
Last Update Date: 08/15/2024
Certification Date: 08/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 SOUTHERN AVE SE
WASHINGTON DC
20032-4623
US

IV. Provider business mailing address

11303 GOLDEN EAGLE PL UNIT B
WALDORF MD
20603-5989
US

V. Phone/Fax

Practice location:
  • Phone: 202-574-6530
  • Fax:
Mailing address:
  • Phone: 703-475-9560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License NumberRC2051
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: