Provider Demographics
NPI:1063714327
Name:LONG, SHAMARA DENISE (MSN, RN)
Entity type:Individual
Prefix:MS
First Name:SHAMARA
Middle Name:DENISE
Last Name:LONG
Suffix:
Gender:F
Credentials:MSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:11609 NEON RD
Mailing Address - Street 2:
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20744-5152
Mailing Address - Country:US
Mailing Address - Phone:202-860-4888
Mailing Address - Fax:
Practice Address - Street 1:2021 K ST NW STE 701
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20006-1054
Practice Address - Country:US
Practice Address - Phone:301-664-2148
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-18
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GAMT004968173C00000X, 225700000X
DCRN1052788364SW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SW0102XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistWomen's Health
No173C00000XOther Service ProvidersReflexologist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist