Healthcare Provider Details

I. General information

NPI: 1487603387
Provider Name (Legal Business Name): SHOBA A. DANEY D.M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15204 OMEGA DR SUITE 140
ROCKVILLE MD
20850-4601
US

IV. Provider business mailing address

9417 WING FOOT CT
POTOMAC MD
20854-5488
US

V. Phone/Fax

Practice location:
  • Phone: 301-869-7733
  • Fax: 301-869-7703
Mailing address:
  • Phone: 301-469-6606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number12369
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: