MEDICARE: SHEWILL CO

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	246ZA2600X	Medical Art Specialist/Technologist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3014312116	OTHER		SALON

General Provider Information

NPI Number	:	1669180667
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHEWILL CO

Provider Business Mailing Address
First Line	:	910 GIST AVE
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20910-4943
Country	:	US
Telephone Number	:	301-562-8311
Fax Number	:

Provider Business Practice Location Address
First Line	:	910 GIST AVE
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20910-4943
Country	:	US
Telephone Number	:	301-562-8311
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. SHELTON WILLIAMS
Credential	:
Telephone Number	:	301-562-8311

Provider Enumeration Date	:	11/08/2022
Last Update Date	:	11/08/2022

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Directions to “SHEWILL CO ” Practice Location

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