Healthcare Provider Details

I. General information

NPI: 1912744343
Provider Name (Legal Business Name): SHANNEIL SERENE GUZMAN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2024
Last Update Date: 08/12/2024
Certification Date: 08/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 IRVING ST NW STE 4100
WASHINGTON DC
20010-2971
US

IV. Provider business mailing address

PO BOX 749495
ATLANTA GA
30374-9495
US

V. Phone/Fax

Practice location:
  • Phone: 202-726-0941
  • Fax: 301-593-9036
Mailing address:
  • Phone: 855-963-2100
  • Fax: 239-236-2775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR223701
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: