Healthcare Provider Details

I. General information

NPI: 1821723347
Provider Name (Legal Business Name): EMILY SHUE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2022
Last Update Date: 12/18/2024
Certification Date: 12/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5268 NICHOLSON LN
KENSINGTON MD
20895-1009
US

IV. Provider business mailing address

5268 NICHOLSON LN
KENSINGTON MD
20895-1009
US

V. Phone/Fax

Practice location:
  • Phone: 301-770-5437
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P0010X
TaxonomyPediatric Rehabilitation Medicine Physician
License Number28967
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: