Provider Demographics
NPI:1598531147
Name:HEALY, SHAVONNE R (MSDH, RDH)
Entity Type:Individual
Prefix:
First Name:SHAVONNE
Middle Name:R
Last Name:HEALY
Suffix:
Gender:F
Credentials:MSDH, RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4005 9TH ST NE APT 3
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20017-3704
Mailing Address - Country:US
Mailing Address - Phone:781-244-0139
Mailing Address - Fax:
Practice Address - Street 1:4005 9TH ST NE APT 3
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20017-3704
Practice Address - Country:US
Practice Address - Phone:781-244-0139
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD7760124Q00000X
DCHYG1000648124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist