Healthcare Provider Details

I. General information

NPI: 1912423070
Provider Name (Legal Business Name): BINTA SHAW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2017
Last Update Date: 01/29/2025
Certification Date: 01/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6608 ADRIAN ST
NEW CARROLLTON MD
20784-3610
US

IV. Provider business mailing address

6608 ADRIAN ST
NEW CARROLLTON MD
20784-3610
US

V. Phone/Fax

Practice location:
  • Phone: 240-413-7311
  • Fax:
Mailing address:
  • Phone: 240-726-2247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number13008
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: