Provider Demographics
NPI:1063086783
Name:SHIRD, JAMES DERRICK
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:DERRICK
Last Name:SHIRD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3453 BRUTON PARISH WAY
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-4845
Mailing Address - Country:US
Mailing Address - Phone:202-528-0459
Mailing Address - Fax:
Practice Address - Street 1:748 BRANDYWINE ST SE APT 204
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-3564
Practice Address - Country:US
Practice Address - Phone:202-246-5387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-17
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant