Healthcare Provider Details

I. General information

NPI: 1912302688
Provider Name (Legal Business Name): JERSIRA SHINDOH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2014
Last Update Date: 10/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9873 GOOD LUCK RD APT 1
LANHAM MD
20706-3230
US

IV. Provider business mailing address

9873 GOOD LUCK RD APT 1
LANHAM MD
20706-3230
US

V. Phone/Fax

Practice location:
  • Phone: 202-520-3689
  • Fax:
Mailing address:
  • Phone: 202-520-3689
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number10975
License Number StateDC

VIII. Authorized Official

Name: MS. JERSIRA SHINDOH
Title or Position: HHA
Credential:
Phone: 202-520-3689