Provider Demographics
NPI:1306212857
Name:JOHNSON, SHAMEKA NICOLE (PHD)
Entity Type:Individual
Prefix:DR
First Name:SHAMEKA
Middle Name:NICOLE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1203 FIDLER LN
Mailing Address - Street 2:APT. 1213
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-3490
Mailing Address - Country:US
Mailing Address - Phone:609-568-0358
Mailing Address - Fax:
Practice Address - Street 1:1203 FIDLER LN
Practice Address - Street 2:APT. 1213
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-3490
Practice Address - Country:US
Practice Address - Phone:609-568-0358
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-19
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC000290235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist