Healthcare Provider Details

I. General information

NPI: 1578335592
Provider Name (Legal Business Name): SHAMISO CHITAMBIRA FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2023
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 KINGS DR
TANEYTOWN MD
21787-2331
US

IV. Provider business mailing address

1 KINGS DR
TANEYTOWN MD
21787-2331
US

V. Phone/Fax

Practice location:
  • Phone: 443-937-6258
  • Fax: 833-471-5617
Mailing address:
  • Phone: 443-937-6258
  • Fax: 833-471-5617

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR206768
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: