Provider Demographics
NPI:1598527186
Name:ANDERSON, SHANICE DANIELLE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SHANICE
Middle Name:DANIELLE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 RIPLEY ST APT 719
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-7423
Mailing Address - Country:US
Mailing Address - Phone:860-478-0328
Mailing Address - Fax:
Practice Address - Street 1:400 7TH ST NW STE 500
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20004-2324
Practice Address - Country:US
Practice Address - Phone:202-963-7780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-29
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPSYA200001399103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical