Healthcare Provider Details

I. General information

NPI: 1619502812
Provider Name (Legal Business Name): TANSHANICKA SHELLAMICE HELEM DNP, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TANSHANICKA SHELLAMICE COLEMAN RN

II. Dates (important events)

Enumeration Date: 03/08/2020
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3261 OLD WASHINGTON RD
WALDORF MD
20602-3223
US

IV. Provider business mailing address

3261 OLD WASHINGTON RD STE J-2020
WALDORF MD
20602-3223
US

V. Phone/Fax

Practice location:
  • Phone: 301-200-5790
  • Fax:
Mailing address:
  • Phone: 301-200-5790
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP67553
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR143602
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1136376
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5017872
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: