Healthcare Provider Details

I. General information

NPI: 1255153086
Provider Name (Legal Business Name): SHANIA DEAGRELLA APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2024
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1475 TANEY AVE STE 102
FREDERICK MD
21702-5126
US

IV. Provider business mailing address

1475 TANEY AVE STE 102
FREDERICK MD
21702-5126
US

V. Phone/Fax

Practice location:
  • Phone: 301-276-7031
  • Fax:
Mailing address:
  • Phone: 301-276-7031
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR237330
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: