MEDICARE: SHALINI BALRAM FNP

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	R225851	MD

General Provider Information

NPI Number	:	1396431870
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHALINI BALRAM FNP

Provider Business Mailing Address
First Line	:	3501 JOHN SIMMONS ST STE A201
Second Line	:
City	:	URBANA
State	:	MD
Zip	:	21704-7964
Country	:	US
Telephone Number	:	240-699-1050
Fax Number	:	410-367-2353

Provider Business Practice Location Address
First Line	:	3501 JOHN SIMMONS ST STE A201
Second Line	:
City	:	URBANA
State	:	MD
Zip	:	21704-7964
Country	:	US
Telephone Number	:	240-699-1050
Fax Number	:	410-367-2353

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

Provider Enumeration Date	:	04/17/2023
Last Update Date	:	04/17/2023

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