Healthcare Provider Details

I. General information

NPI: 1265148878
Provider Name (Legal Business Name): SHAYONNA ESCALERA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2023
Last Update Date: 01/26/2023
Certification Date: 01/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4211 BLAKELY AVE STE 201
NOTTINGHAM MD
21236-2458
US

IV. Provider business mailing address

5821 WHITE LAKE LN APT 307
FREDERICK MD
21703-2928
US

V. Phone/Fax

Practice location:
  • Phone: 570-903-2995
  • Fax:
Mailing address:
  • Phone: 570-903-2995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: