Provider Demographics
NPI:1811651342
Name:SUBRYAN, SHIRLEY ROSE (EDD)
Entity type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:ROSE
Last Name:SUBRYAN
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2207 DUNROBIN DR
Mailing Address - Street 2:
Mailing Address - City:MITCHELLVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-2831
Mailing Address - Country:US
Mailing Address - Phone:240-505-9196
Mailing Address - Fax:
Practice Address - Street 1:2207 DUNROBIN DR
Practice Address - Street 2:
Practice Address - City:MITCHELLVILLE
Practice Address - State:MD
Practice Address - Zip Code:20721-2831
Practice Address - Country:US
Practice Address - Phone:240-505-9196
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-30
Last Update Date:2021-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC8946101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional