Provider Demographics
NPI:1649430075
Name:SAMUEL, SHEREEN KHANDAGLE (DO)
Entity type:Individual
Prefix:
First Name:SHEREEN
Middle Name:KHANDAGLE
Last Name:SAMUEL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8355 CHERRY LN
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-4829
Mailing Address - Country:US
Mailing Address - Phone:301-725-4341
Mailing Address - Fax:301-317-9070
Practice Address - Street 1:8355 CHERRY LN
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-4829
Practice Address - Country:US
Practice Address - Phone:301-725-4341
Practice Address - Fax:301-317-9070
Is Sole Proprietor?:No
Enumeration Date:2008-06-10
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH69508208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics