Provider Demographics
NPI:1275738965
Name:SHAHEED, SANDRA BOYD (APRN)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:BOYD
Last Name:SHAHEED
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7306 CIRCLE DR E
Mailing Address - Street 2:
Mailing Address - City:OXON HILL
Mailing Address - State:MD
Mailing Address - Zip Code:20745-1714
Mailing Address - Country:US
Mailing Address - Phone:301-567-8891
Mailing Address - Fax:
Practice Address - Street 1:7306 CIRCLE DR E
Practice Address - Street 2:
Practice Address - City:OXON HILL
Practice Address - State:MD
Practice Address - Zip Code:20745-1714
Practice Address - Country:US
Practice Address - Phone:301-567-8891
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-20
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR070214363LA2100X, 363LF0000X
VA0024166447363LF0000X
DCRN41201363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD082NS083Medicare PIN
MD003144M72Medicare UPIN