Healthcare Provider Details

I. General information

NPI: 1720784549
Provider Name (Legal Business Name): CANDACE NAYISHA SHILLINGFORD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2023
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

903 BRIGHTSEAT RD # 201
LANDOVER MD
20785-4725
US

IV. Provider business mailing address

122 WESTWAY APT 201
GREENBELT MD
20770-1914
US

V. Phone/Fax

Practice location:
  • Phone: 267-934-1082
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number28210
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: