Healthcare Provider Details

I. General information

NPI: 1174981922
Provider Name (Legal Business Name): LEAH PL SHOVAL MSN, CPNP-PC, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2016
Last Update Date: 10/02/2024
Certification Date: 10/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8630 FENTON ST STE 1200
SILVER SPRING MD
20910-3808
US

IV. Provider business mailing address

5523 13TH ST NW
WASHINGTON DC
20011-3501
US

V. Phone/Fax

Practice location:
  • Phone: 15-851-2503
  • Fax: 301-585-6289
Mailing address:
  • Phone: 310-779-7466
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN1030144
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberL-88331
License Number StateDC
# 3
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberNP1030144
License Number StateDC
# 4
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberR244915
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: