Provider Demographics
NPI:1013620202
Name:SHUFFORD, CAROLINE GUINIVERE (PT)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:GUINIVERE
Last Name:SHUFFORD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5306 MORELLO RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21214-2130
Mailing Address - Country:US
Mailing Address - Phone:410-984-8443
Mailing Address - Fax:
Practice Address - Street 1:1601 E BELVEDERE AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21239-3004
Practice Address - Country:US
Practice Address - Phone:410-532-5600
Practice Address - Fax:410-532-8141
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-03
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16669225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty