Healthcare Provider Details

I. General information

NPI: 1508721309
Provider Name (Legal Business Name): SHALAILA FERGUSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2025
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 BANNER LN NW APT 332
WASHINGTON DC
20001-6136
US

IV. Provider business mailing address

1732 ADDISON RS SOUTH
DISTRICT HEIGHTS MD
20747
US

V. Phone/Fax

Practice location:
  • Phone: 301-433-9104
  • Fax: 301-433-9104
Mailing address:
  • Phone: 301-433-9104
  • Fax: 301-433-9104

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: