Healthcare Provider Details

I. General information

NPI: 1447447974
Provider Name (Legal Business Name): SHOBHA SOLOMON MS, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2007
Last Update Date: 11/23/2020
Certification Date: 11/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9318 GAITHER RD STE 245
GAITHERSBURG MD
20877-1423
US

IV. Provider business mailing address

2040 MAYFLOWER DR
SILVER SPRING MD
20905-5563
US

V. Phone/Fax

Practice location:
  • Phone: 301-367-1533
  • Fax: 301-527-0703
Mailing address:
  • Phone: 301-367-1533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR120906
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: