Healthcare Provider Details

I. General information

NPI: 1083549208
Provider Name (Legal Business Name): SHAMINGA CHEATHAM LICENSED ESTHETICIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MING CHEATHAM

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13017 WISTERIA DR # 105
GERMANTOWN MD
20874-2621
US

IV. Provider business mailing address

13017 WISTERIA DR # 105
GERMANTOWN MD
20874-2621
US

V. Phone/Fax

Practice location:
  • Phone: 667-300-8898
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175L00000X
TaxonomyHomeopath
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: