Provider Demographics
NPI:1629823646
Name:SHEPHERDHEALTHCARE SYSTEM,LLC
Entity type:Organization
Organization Name:SHEPHERDHEALTHCARE SYSTEM,LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:FOLUKE
Authorized Official - Middle Name:O
Authorized Official - Last Name:AJUWON
Authorized Official - Suffix:
Authorized Official - Credentials:DNP/CRNP
Authorized Official - Phone:240-938-4333
Mailing Address - Street 1:15320 OLD FREDERICK RD
Mailing Address - Street 2:
Mailing Address - City:WOODBINE
Mailing Address - State:MD
Mailing Address - Zip Code:21797-8748
Mailing Address - Country:US
Mailing Address - Phone:240-938-4333
Mailing Address - Fax:410-934-4815
Practice Address - Street 1:312 MARSHALL AVE STE 1010
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-4861
Practice Address - Country:US
Practice Address - Phone:410-934-4813
Practice Address - Fax:410-934-4815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-22
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty