Healthcare Provider Details

I. General information

NPI: 1295645018
Provider Name (Legal Business Name): SHAWNTEL KIDWELL
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

1208 KIRBY ST NW
WASHINGTON DC
20001-1203
US

IV. Provider business mailing address

603 BRANDON GREEN DR
SILVER SPRING MD
20904-3589
US

V. Phone/Fax

Practice location:
  • Phone: 202-423-7616
  • Fax:
Mailing address:
  • Phone: 240-370-5460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: