Healthcare Provider Details

I. General information

NPI: 1215485834
Provider Name (Legal Business Name): MEGHAN ELIZABETH SHAND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2016
Last Update Date: 09/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18229 DUPONT BLVD
GEORGETOWN DE
19947-3127
US

IV. Provider business mailing address

106 RIVERSIDE TER
CHESTERTOWN MD
21620-1632
US

V. Phone/Fax

Practice location:
  • Phone: 302-519-1616
  • Fax:
Mailing address:
  • Phone: 302-519-1616
  • Fax: 302-253-8028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT-0003597
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: