Healthcare Provider Details

I. General information

NPI: 1225226822
Provider Name (Legal Business Name): ROBIYALE SHELLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2007
Last Update Date: 12/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 RIVA RD
ANNAPOLIS MD
21401-7304
US

IV. Provider business mailing address

11513 BIG CREEK DR
BELTSVILLE MD
20705-1456
US

V. Phone/Fax

Practice location:
  • Phone: 866-389-2727
  • Fax: 401-652-9787
Mailing address:
  • Phone: 301-529-7007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number142141
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: