Provider Demographics
NPI:1609001072
Name:SHLAKMAN, SAMANTHA ALYSE (MD)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:ALYSE
Last Name:SHLAKMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 CONNECTICUT AVE NW STE 1225
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20036-1718
Mailing Address - Country:US
Mailing Address - Phone:202-421-7408
Mailing Address - Fax:
Practice Address - Street 1:501 CHURCH ST NE
Practice Address - Street 2:SUITE 217
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180-4734
Practice Address - Country:US
Practice Address - Phone:202-421-7408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-28
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD0374662084P0800X
VA01012485652084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry