Provider Demographics
NPI:1689215527
Name:TEFERI, ELSHADAY (NP)
Entity Type:Individual
Prefix:
First Name:ELSHADAY
Middle Name:
Last Name:TEFERI
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 1:5500 KNOLL NORTH DR STE 290
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-2389
Mailing Address - Country:US
Mailing Address - Phone:301-317-6575
Mailing Address - Fax:
Practice Address - Street 1:5500 KNOLL NORTH DR STE 290
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-2389
Practice Address - Country:US
Practice Address - Phone:301-317-6575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-02
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024178141363LP2300X
MDAC002925363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care