Healthcare Provider Details

I. General information

NPI: 1225994643
Provider Name (Legal Business Name): SHANNON DANIELLE BOYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/30/2025
Last Update Date: 12/30/2025
Certification Date: 12/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10800 GEORGIA AVE APT T1
SILVER SPRING MD
20902-4725
US

IV. Provider business mailing address

10800 GEORGIA AVE APT T1
SILVER SPRING MD
20902-4725
US

V. Phone/Fax

Practice location:
  • Phone: 202-839-2675
  • Fax:
Mailing address:
  • Phone: 202-839-2675
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License NumberNPCN-16925-5578
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: