Healthcare Provider Details

I. General information

NPI: 1316826019
Provider Name (Legal Business Name): SHANELLE DEBRAUX PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2025
Last Update Date: 08/28/2025
Certification Date: 08/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15600 COLUMBIA PIKE
BURTONSVILLE MD
20866-1630
US

IV. Provider business mailing address

4851 ELLIN RD APT 237
HYATTSVILLE MD
20784-1772
US

V. Phone/Fax

Practice location:
  • Phone: 301-421-9060
  • Fax:
Mailing address:
  • Phone: 240-441-9696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number29646
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: