Provider Demographics
NPI:1245002542
Name:DECRUISE, SHELIA
Entity type:Individual
Prefix:
First Name:SHELIA
Middle Name:
Last Name:DECRUISE
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 1:4100 AMES ST NE APT F44
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20019-3383
Mailing Address - Country:US
Mailing Address - Phone:202-515-8979
Mailing Address - Fax:
Practice Address - Street 1:3417 18TH ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20018-2721
Practice Address - Country:US
Practice Address - Phone:202-629-2917
Practice Address - Fax:202-629-2797
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-30
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator