Healthcare Provider Details

I. General information

NPI: 1699920124
Provider Name (Legal Business Name): SHIRA SPILMAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2008
Last Update Date: 07/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9420 KEY WEST AVENUE SUITE 202
ROCKVILLE MD
20850-6288
US

IV. Provider business mailing address

12510 PROSPERITY DR SUITE 200
SILVER SPRING MD
20904-1663
US

V. Phone/Fax

Practice location:
  • Phone: 301-251-9555
  • Fax: 301-309-0765
Mailing address:
  • Phone: 240-485-5200
  • Fax: 301-625-6906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA053634
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC0004227
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: