Healthcare Provider Details

I. General information

NPI: 1700434131
Provider Name (Legal Business Name): SHAUNTE ANNTONITTE SPRUILL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2019
Last Update Date: 08/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3348 BLAINE ST NE
WASHINGTON DC
20019-1327
US

IV. Provider business mailing address

4142 SUITLAND RD APT 302
SUITLAND MD
20746-2015
US

V. Phone/Fax

Practice location:
  • Phone: 202-399-2966
  • Fax:
Mailing address:
  • Phone: 240-593-5872
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: