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General NPI Number Information
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NPI Number | 1679152441
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Entity Type | Individual
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Provider Name | SHONNELL SHELTON
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Gender | Female
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Dates
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Enumeration Date | 04/07/2021
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Last Update Date | 09/21/2021
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Provider Practice Location Address
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Address Line | 9811 MALLARD DR STE 203
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City | LAUREL
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State | MD
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Zip | 20708-3199
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Country | US
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Telephone | 301-778-8835
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Fax |
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Provider Business Mailing Address
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Address Line | 13603 AVEBURY DR APT 12
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City | LAUREL
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State | MD
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Zip | 20708-3439
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Country | US
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Telephone | 240-918-0861
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | LG50081504
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License Number State | DC
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Taxonomy #3
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 21094
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License Number State | MD
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Taxonomy #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 21094
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License Number State | MD
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