Healthcare Provider Details

I. General information

NPI: 1932557139
Provider Name (Legal Business Name): SHOSHANA FELDMAN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2016
Last Update Date: 11/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18109 PRINCE PHILIP DR
OLNEY MD
20832-1519
US

IV. Provider business mailing address

18109 PRINCE PHILIP DR
OLNEY MD
20832-1519
US

V. Phone/Fax

Practice location:
  • Phone: 301-774-8962
  • Fax:
Mailing address:
  • Phone: 301-774-8962
  • Fax: 301-774-8963

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR191739
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR191739
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN1043164
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: