Healthcare Provider Details

I. General information

NPI: 1902715238
Provider Name (Legal Business Name): SHELBY JUPITER LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6917 ARLINGTON RD STE G2
BETHESDA MD
20814-5211
US

IV. Provider business mailing address

9701 SKYHILL WAY APT 408
ROCKVILLE MD
20850-4835
US

V. Phone/Fax

Practice location:
  • Phone: 301-701-6046
  • Fax:
Mailing address:
  • Phone: 301-701-6046
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberM06201
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: