Healthcare Provider Details

I. General information

NPI: 1053294074
Provider Name (Legal Business Name): SHANNON LLANES MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2025
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

139 N MAIN ST STE 301
BEL AIR MD
21014-8808
US

IV. Provider business mailing address

10605 SHADY CIR
SILVER SPRING MD
20903-1236
US

V. Phone/Fax

Practice location:
  • Phone: 443-567-7037
  • Fax:
Mailing address:
  • Phone: 240-429-8601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number33516
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: