Provider Demographics
NPI:1801225149
Name:PEARSON, SHAUNA LEE (ATC)
Entity type:Individual
Prefix:MRS
First Name:SHAUNA
Middle Name:LEE
Last Name:PEARSON
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:MISS
Other - First Name:SHAUNA
Other - Middle Name:LEE
Other - Last Name:HENRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:16703 WARDLOW RD
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-3447
Mailing Address - Country:US
Mailing Address - Phone:301-613-6608
Mailing Address - Fax:
Practice Address - Street 1:4313 MADISON ST
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20781-1625
Practice Address - Country:US
Practice Address - Phone:240-764-2253
Practice Address - Fax:240-764-2275
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-07
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA00003892255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer