Provider Demographics
NPI:1740971761
Name:SWARUP, SHAILENDRA (CRNP-PMH)
Entity type:Individual
Prefix:MR
First Name:SHAILENDRA
Middle Name:
Last Name:SWARUP
Suffix:
Gender:M
Credentials:CRNP-PMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 FORBES BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-6316
Mailing Address - Country:US
Mailing Address - Phone:866-384-8110
Mailing Address - Fax:301-560-8244
Practice Address - Street 1:4500 FORBES BLVD STE 200
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-6316
Practice Address - Country:US
Practice Address - Phone:866-384-8110
Practice Address - Fax:301-560-8244
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-19
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR1933562084P0800X, 2084P0805X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDR193356OtherCRNP