Provider Demographics
NPI:1689211518
Name:VALLIATH, SHELLY SHARMA (NP)
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:SHARMA
Last Name:VALLIATH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6000 EXECUTIVE BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-3816
Mailing Address - Country:US
Mailing Address - Phone:240-599-1001
Mailing Address - Fax:240-599-1001
Practice Address - Street 1:6000 EXECUTIVE BLVD STE 101
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-3816
Practice Address - Country:US
Practice Address - Phone:240-599-1001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-10
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR226136363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily