Healthcare Provider Details

I. General information

NPI: 1740971761
Provider Name (Legal Business Name): SHAILENDRA SWARUP CRNP-PMH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2023
Last Update Date: 05/19/2023
Certification Date: 05/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 FORBES BLVD STE 200
LANHAM MD
20706-6316
US

IV. Provider business mailing address

4500 FORBES BLVD STE 200
LANHAM MD
20706-6316
US

V. Phone/Fax

Practice location:
  • Phone: 866-384-8110
  • Fax: 301-560-8244
Mailing address:
  • Phone: 866-384-8110
  • Fax: 301-560-8244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR193356
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberR193356
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License NumberR193356
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: