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General NPI Number Information
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NPI Number | 1376209809
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Entity Type | Individual
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Provider Name | CHANDRA SHAW RN
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Gender | Female
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Dates
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Enumeration Date | 11/09/2021
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Last Update Date | 11/09/2021
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Provider Practice Location Address
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Address Line | 827 LINDEN AVE
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City | BALTIMORE
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State | MD
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Zip | 21201-4606
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Country | US
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Telephone | 410-225-8000
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Fax |
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Provider Business Mailing Address
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Address Line | 11851 MONUMENT DR APT 208
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City | FAIRFAX
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State | VA
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Zip | 22030-8726
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Country | US
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Telephone | 770-616-9111
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WC0200X
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Taxonomy Name | Critical Care Medicine Registered Nurse
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License Number | 0001294677
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License Number State | VA
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