Healthcare Provider Details

I. General information

NPI: 1194278325
Provider Name (Legal Business Name): DR. SHAVONNE CLARICE BEACHUM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2016
Last Update Date: 05/24/2026
Certification Date: 05/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 E JOPPA RD STE 332
TOWSON MD
21286-5811
US

IV. Provider business mailing address

7434 WILD HONEY WAY
ELKRIDGE MD
21075-7292
US

V. Phone/Fax

Practice location:
  • Phone: 443-353-9547
  • Fax:
Mailing address:
  • Phone: 667-349-4676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: