Healthcare Provider Details

I. General information

NPI: 1083526842
Provider Name (Legal Business Name): ELAINE SHANKUTE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 N QUINCY ST
ARLINGTON VA
22203-2136
US

IV. Provider business mailing address

200 N GLEBE RD STE 104
ARLINGTON VA
22203-3755
US

V. Phone/Fax

Practice location:
  • Phone: 703-841-0703
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number0701016670
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: