Provider Demographics
NPI:1235685280
Name:SHANKLE, ALEXANDRA (PA-C, MPH)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:SHANKLE
Suffix:
Gender:F
Credentials:PA-C, MPH
Other - Prefix:
Other - First Name:ALEXANDRA
Other - Middle Name:
Other - Last Name:RHEAUME
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3000 SPOUT RUN PKWY
Mailing Address - Street 2:#C604
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22201-4232
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:20010 CENTURY BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-1115
Practice Address - Country:US
Practice Address - Phone:888-541-6368
Practice Address - Fax:240-780-7735
Is Sole Proprietor?:No
Enumeration Date:2016-08-30
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110005494363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant