SHANELLE MOORE (NPI# 1669028338) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1669028338 |
| Entity Type | Individual |
| Full Name | SHANELLE MOORE |
| Practice Address |
1221 Mercantile Ln Largo MD 20774-5374 |
| Mailing Address |
1409 Whistling Duck Dr Upper Marlboro MD 20774-7078 |
| Practice Telephone | 3016185500 |
| Enumeration Date | 2019-08-17 |
| Last Update Date | 2019-08-17 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207QA0505X |
Family Medicine Specialization: Adult Medicine |
207QA0505X | MD | Allopathic & Osteopathic Physicians |
| Street Address |
1221 MERCANTILE LN |
| City | LARGO |
| State | MD |
| Zip Code | 20774-5374 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164425419 | Stephen J Ilario | Orthopaedic Surgery | 1221 Mercantile Ln, Largo, MD 20774-5374 | 2005-05-31 |
| 1780215020 | Malika Tamara Haylock-jones | Nurse Practitioner | 1221 Mercantile Ln, Largo, MD 20774-5374 | 2020-01-27 |
| 1346888427 | Kaiser Foundation Health Plan of The Mid-atlantic States, Inc. | Clinic/Center | 1221 Mercantile Ln, Largo, MD 20774-5374 | 2019-12-19 |
| 1164069449 | Ashasha Tselat Sumbatyan | Physical Therapy Assistant | 1221 Mercantile Ln, Largo, MD 20774-5374 | 2019-12-05 |
| 1598316184 | Deepa L Cruz | Registered Nurse | 1221 Mercantile Ln, Largo, MD 20774-5374 | 2019-09-25 |
| 1639720204 | Charmaine Andra Mckie | Registered Nurse | 1221 Mercantile Ln, Largo, MD 20774-5374 | 2019-09-25 |
| 1356815112 | Nanah Hannah Sevalie | Nurse Practitioner | 1221 Mercantile Ln, Largo, MD 20774-5374 | 2019-01-15 |
| 1215436183 | Shadana Maddox | Pharmacist | 1221 Mercantile Ln, Largo, MD 20774-5374 | 2018-02-06 |
| 1336650878 | Kyla Trenay Scott | Registered Nurse | 1221 Mercantile Ln, Largo, MD 20774-5374 | 2017-10-23 |
| 1235667270 | Onyekachukwu Ada Ihezie | Pharmacist | 1221 Mercantile Ln, Largo, MD 20774-5374 | 2017-06-02 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922637156 | Marie Charlotte Teboutsou Tsodzou | Nurse Practitioner | 9317 Lavall Drive, Upper Marlboro, MD 20774 | 2020-04-08 |
| 1467093443 | Richland Support Services Corp. | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 11551 Joyceton Drive, Upper Marlboro, MD 20774 | 2019-10-01 |
| 1770134124 | Alan L Kahn | Counselor | 301 Largo Rd., Largo, MD 20774 | 2019-09-26 |
| 1619522034 | Francisca Ifeoma Alintah | Registered Nurse | 511 Dennis Magruder Dr., Upper Marlboro, MD 20774 | 2019-08-02 |
| 1609337146 | Crystal Osuchukwu | Counselor | 1300 Mccormick Dr, Upper Marlboro, MD 20774 | 2019-03-27 |
| 1861968489 | Collaborative Concepts of Maryland | Counselor | 1400 Mercantile Lane, Suite 208, Largo, MD 20774 | 2018-10-22 |
| 1073097622 | Triple Angels Homecare Services, Inc. | In Home Supportive Care | 1210 Dixie Bowie Way, Upper Marlboro, MD 20774 | 2018-09-19 |
| 1922589654 | Optimum Resource Services, LLC | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 711 Harry S. Truman Dr, Unit #105, Largo, MD 20774 | 2018-08-21 |
| 1811475254 | Kolawole Richard Olatunde | Home Health Aide | 11405 Villa Court, Upper Marlboro, MD 20774 | 2018-07-28 |
| 1548747769 | Tiara Williams | Counselor | 15207 Harriet Clotilda Way, Upper Marlboro, MD 20774 | 2018-07-20 |
| Find all providers in zip 20774 | ||||
| Taxonomy Code | 207QA0505X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Specialization | Adult Medicine |
| Definition to come. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114312758 | Idongesit Iheanyichukwu Attang | Family Medicine | 1221 Mercantile Lane, Largo, MD 20774 | 2015-03-31 |
| 1659716256 | Cynthia Chika Odogwu | Family Medicine | 1221 Mercantile Ln, Largo, MD 20774-5374 | 2013-05-08 |
| 1992979546 | Young Foundational Health Center | Family Medicine | 7241 Bryan Dairy Rd, Largo, FL 33777 | 2008-04-15 |
| 1548382153 | Esther Nnenna Nwogu | Family Medicine | 1221 Mercantile Ln, Largo, MD 20774-5374 | 2007-04-04 |
| 1538230263 | Douglas Murray Baird IIi | Family Medicine | 13540 Walsingham Rd, Largo, FL 33774-3546 | 2006-11-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386245371 | Cynthia Tessie | Family Medicine | 1398 Hawthorn Dr, Hanover, MD 21076-2197 | 2020-11-05 |
| 1093354920 | Irina Konstantinovna Baum | Family Medicine | 3893 Fortress Ct, Hampstead, MD 21074-1790 | 2019-12-23 |
| 1972140242 | Abisola Omowumi Alade | Family Medicine | 9312 Silver Charm Dr, Randallstown, MD 21133-4610 | 2019-12-05 |
| 1336799634 | Abosede Adeniji Sakariyah | Family Medicine | 18403 Woodhouse Ln, Germantown, MD 20874-4110 | 2019-09-18 |
| 1962960229 | Parkville Medical Group LLC | Family Medicine | 1721 Belfast Rd, Sparks, MD 21152-9786 | 2019-03-06 |
| 1548665771 | Robert Charles Frey | Family Medicine | 801 Richardson Dr, Harwood, MD 20776-9463 | 2014-10-30 |
| 1639571573 | C. Gottfried Baumann | Family Medicine | 8293 Brices Mill Rd, Chestertown, MD 21620-4678 | 2014-09-23 |
| 1184067514 | Vijaya Lakshmi Alla | Family Medicine | 6014 Old Branch Avenue, Temple Hills, MD 20748 | 2013-04-16 |
| 1750623393 | William Nicholas Fishbein | Family Medicine | 13549 Scottish Autumn Ln, Gaithersburg, MD 20878-3990 | 2013-03-21 |
| 1114273844 | Kum Hai Lee | Family Medicine | 815 Woodley Dr, Rockville, MD 20850-2033 | 2012-07-31 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.