Provider Demographics
NPI:1639489032
Name:SHAMIS, INNA
Entity Type:Individual
Prefix:
First Name:INNA
Middle Name:
Last Name:SHAMIS
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 1:10110 MOLECULAR DRIVE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850
Mailing Address - Country:US
Mailing Address - Phone:301-279-2779
Mailing Address - Fax:301-279-2767
Practice Address - Street 1:10110 MOLECULAR DR STE 206
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-7542
Practice Address - Country:US
Practice Address - Phone:301-279-2779
Practice Address - Fax:301-279-2767
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1008161363L00000X
MDR165785363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD052703300Medicaid
DC076053600Medicaid