Healthcare Provider Details

I. General information

NPI: 1265692693
Provider Name (Legal Business Name): BROOKE ALANNA SHUSTER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2008
Last Update Date: 06/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 GALLOWS RD
FALLS CHURCH VA
22042
US

IV. Provider business mailing address

508 N COLUMBUS ST
ALEXANDRIA VA
22314-2216
US

V. Phone/Fax

Practice location:
  • Phone: 703-776-4238
  • Fax:
Mailing address:
  • Phone: 585-507-8230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number#MD038876
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD72333
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number0101252909
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: