Healthcare Provider Details

I. General information

NPI: 1922871300
Provider Name (Legal Business Name): TARA SHIMER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2023
Last Update Date: 11/06/2023
Certification Date: 11/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

912 N BELGRADE RD
SILVER SPRING MD
20902-3248
US

IV. Provider business mailing address

912 N BELGRADE RD
SILVER SPRING MD
20902-3248
US

V. Phone/Fax

Practice location:
  • Phone: 301-404-9528
  • Fax: 301-576-5014
Mailing address:
  • Phone: 301-404-9528
  • Fax: 301-576-5014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: