Healthcare Provider Details

I. General information

NPI: 1598101859
Provider Name (Legal Business Name): SHAAN SUDHAKARAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2013
Last Update Date: 07/26/2021
Certification Date: 07/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8455 COLESVILLE RD STE 200
SILVER SPRING MD
20910-6347
US

IV. Provider business mailing address

11350 MCCORMICK ROAD EXECUTIVE PLAZA 1, SUITE 501
HUNT VALLEY MD
21031
US

V. Phone/Fax

Practice location:
  • Phone: 301-960-5958
  • Fax:
Mailing address:
  • Phone: 410-329-1071
  • Fax: 410-329-1054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD046389
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberMD046389
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: