Provider Demographics
NPI:1780307645
Name:BURRELL, RASHEEAH
Entity type:Individual
Prefix:
First Name:RASHEEAH
Middle Name:
Last Name:BURRELL
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 1:10 E NORTH AVE STE 6
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21202-4886
Mailing Address - Country:US
Mailing Address - Phone:410-814-8956
Mailing Address - Fax:
Practice Address - Street 1:1814 N CAROLINE ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21213-2205
Practice Address - Country:US
Practice Address - Phone:410-814-8956
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD87-0850919Medicaid