Healthcare Provider Details

I. General information

NPI: 1962671362
Provider Name (Legal Business Name): MICHELLE B SHAY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/29/2008
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5970 FREDERICK CROSSING LN STE 100
FREDERICK MD
21704-5176
US

IV. Provider business mailing address

9426 STEWARTOWN RD 2F
GAITHERSBURG MD
20879-1601
US

V. Phone/Fax

Practice location:
  • Phone: 240-415-8893
  • Fax: 240-466-1993
Mailing address:
  • Phone: 301-208-8900
  • Fax: 301-208-8369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number12469
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: