Healthcare Provider Details

I. General information

NPI: 1033511969
Provider Name (Legal Business Name): SHAWNTA ARMSTEAD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2014
Last Update Date: 09/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6120 KANSAS AVE NE
WASHINGTON DC
20011-1531
US

IV. Provider business mailing address

6411 HIL MAR DR APT 304
DISTRICT HEIGHTS MD
20747-4033
US

V. Phone/Fax

Practice location:
  • Phone: 202-722-7776
  • Fax:
Mailing address:
  • Phone: 301-433-5797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License NumberHHA7462
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: