Healthcare Provider Details

I. General information

NPI: 1194378034
Provider Name (Legal Business Name): SHELLEY RUTH SLAUGHTER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2019
Last Update Date: 07/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109003 NEW HAMPSHIRE AVENUE
SILVER SPRING MD
20993-0002
US

IV. Provider business mailing address

109003 NEW HAMPSHIRE AVENUE
SILVER SPRING MD
20993-0002
US

V. Phone/Fax

Practice location:
  • Phone: 301-796-1001
  • Fax:
Mailing address:
  • Phone: 301-796-1001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License NumberMD20140
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: