Healthcare Provider Details

I. General information

NPI: 1730023748
Provider Name (Legal Business Name): SHANNON NICOLE MULROY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2026
Last Update Date: 04/18/2026
Certification Date: 04/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6710 MALLERY DR
LANHAM MD
20706-3964
US

IV. Provider business mailing address

1925 14TH ST NW APT 702
WASHINGTON DC
20009-6095
US

V. Phone/Fax

Practice location:
  • Phone: 856-834-0698
  • Fax:
Mailing address:
  • Phone: 856-834-0698
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: