Healthcare Provider Details

I. General information

NPI: 1992596290
Provider Name (Legal Business Name): SHAMIRA HARRIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2025
Last Update Date: 05/15/2025
Certification Date: 05/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3104 TIOGA PKWY
BALTIMORE MD
21215-7924
US

IV. Provider business mailing address

1120 N TAYLOR ST
ARLINGTON VA
22201-5638
US

V. Phone/Fax

Practice location:
  • Phone: 540-222-8686
  • Fax:
Mailing address:
  • Phone: 540-222-8986
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: