Provider Demographics
NPI:1205308277
Name:FREEMAN, SHA'LA KENYONA
Entity type:Individual
Prefix:
First Name:SHA'LA
Middle Name:KENYONA
Last Name:FREEMAN
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 1:7210 WENDOVER DR
Mailing Address - Street 2:
Mailing Address - City:DISTRICT HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20747-1742
Mailing Address - Country:US
Mailing Address - Phone:240-353-7385
Mailing Address - Fax:
Practice Address - Street 1:3416 25TH ST SE APT 3
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-1945
Practice Address - Country:US
Practice Address - Phone:202-876-4576
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-01
Last Update Date:2019-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant