Healthcare Provider Details

I. General information

NPI: 1962240655
Provider Name (Legal Business Name): SHANEEN SILK-VALENTINO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2024
Last Update Date: 02/27/2025
Certification Date: 02/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45155 RESEARCH PL STE 140
ASHBURN VA
20147-4193
US

IV. Provider business mailing address

151 SOUTHHALL LN STE 300
MAITLAND FL
32751-7172
US

V. Phone/Fax

Practice location:
  • Phone: 703-858-0500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53-83383-011
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: