MEDICARE: SHAYNA WAITES LICSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	21510	DC
2	1041C0700X	Clinical Social Worker	LC50081584	DC

General Provider Information

NPI Number	:	1205411063
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAYNA WAITES LICSW

Provider Business Mailing Address
First Line	:	13149 MUSICMASTER DR
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20904-6805
Country	:	US
Telephone Number	:	919-523-4272
Fax Number	:

Provider Business Practice Location Address
First Line	:	13149 MUSICMASTER DR
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20904-6805
Country	:	US
Telephone Number	:	919-523-4272
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/13/2021
Last Update Date	:	03/13/2021

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Directions to “ SHAYNA WAITES LICSW” Practice Location

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