Healthcare Provider Details

I. General information

NPI: 1932038361
Provider Name (Legal Business Name): SHAWNTEL DRAKE LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5525 TWIN KNOLLS RD STE 331
COLUMBIA MD
21045-3207
US

IV. Provider business mailing address

5860 STEVENS FOREST RD APT 2
COLUMBIA MD
21045-3796
US

V. Phone/Fax

Practice location:
  • Phone: 443-738-5443
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberM06046
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: