Provider Demographics
NPI:1376953299
Name:HARRIS, SHADONNE (LMT)
Entity Type:Individual
Prefix:
First Name:SHADONNE
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9500 MARLBORO PIKE
Mailing Address - Street 2:SUITE 12
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772
Mailing Address - Country:US
Mailing Address - Phone:301-702-8555
Mailing Address - Fax:301-702-8005
Practice Address - Street 1:9500 MARLBORO PIKE
Practice Address - Street 2:SUITE 12
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20772
Practice Address - Country:US
Practice Address - Phone:301-702-8555
Practice Address - Fax:301-702-8005
Is Sole Proprietor?:No
Enumeration Date:2014-04-30
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD3409225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist