Healthcare Provider Details

I. General information

NPI: 1780825497
Provider Name (Legal Business Name): SHANA MARIE BELLOW PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2009
Last Update Date: 08/26/2021
Certification Date: 08/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 S SHIRLINGTON RD STE 706
ARLINGTON VA
22206-3602
US

IV. Provider business mailing address

PO BOX 37174
BALTIMORE MD
21297-3174
US

V. Phone/Fax

Practice location:
  • Phone: 571-777-2350
  • Fax: 571-777-2331
Mailing address:
  • Phone: 571-423-5699
  • Fax: 571-423-5698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number0810005286
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPSY1000415
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: