MEDICARE: GOLDEN DAYS, LLC

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	363LF0000X	Family Nurse Practitioner	F07141329	MD

General Provider Information

NPI Number	:	1326426958
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOLDEN DAYS, LLC

Provider Business Mailing Address
First Line	:	15480 ANNAPOLIS RD
Second Line	:	STE 202
City	:	BOWIE
State	:	MD
Zip	:	20715-1852
Country	:	US
Telephone Number	:	301-503-1490
Fax Number	:

Provider Business Practice Location Address
First Line	:	15480 ANNAPOLIS RD
Second Line	:	STE 202
City	:	BOWIE
State	:	MD
Zip	:	20715-1852
Country	:	US
Telephone Number	:	301-503-1490
Fax Number	:

Authorized Official
Title or Position	:	FAMILY NURSE PRACTITIONER
Name	:	MRS. SHAVONNE SALAAM
Credential	:	CRNP
Telephone Number	:	301-503-1490

Provider Enumeration Date	:	05/15/2015
Last Update Date	:	09/06/2016

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Directions to “GOLDEN DAYS, LLC ” Practice Location

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