Healthcare Provider Details

I. General information

NPI: 1255198586
Provider Name (Legal Business Name): SHAUNTE HILDEBRAND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2024
Last Update Date: 03/04/2024
Certification Date: 03/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15200 SHADY GROVE RD STE 408
ROCKVILLE MD
20850-3218
US

IV. Provider business mailing address

4912 CHRISTIAN KEMP DR S
FREDERICK MD
21703-2724
US

V. Phone/Fax

Practice location:
  • Phone: 301-926-4408
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number6218
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: