Provider Demographics
NPI:1598134066
Name:OSHIRO, SHANA
Entity Type:Individual
Prefix:
First Name:SHANA
Middle Name:
Last Name:OSHIRO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 DOGWOOD DR
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-5020
Mailing Address - Country:US
Mailing Address - Phone:240-535-7900
Mailing Address - Fax:
Practice Address - Street 1:1301 DOGWOOD DR
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-5020
Practice Address - Country:US
Practice Address - Phone:240-535-7900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-15
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD11006174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist