Provider Demographics
NPI:1154475945
Name:SHORE, FAUSTINA JOSETTE (RN MSN)
Entity type:Individual
Prefix:MS
First Name:FAUSTINA
Middle Name:JOSETTE
Last Name:SHORE
Suffix:
Gender:F
Credentials:RN MSN
Other - Prefix:
Other - First Name:FAUSTINA
Other - Middle Name:JOSETTE
Other - Last Name:CZAWLYTKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:50 W MONTGOMERY AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-4244
Mailing Address - Country:US
Mailing Address - Phone:240-686-5390
Mailing Address - Fax:
Practice Address - Street 1:50 W MONTGOMERY AVE STE 300
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-4244
Practice Address - Country:US
Practice Address - Phone:240-686-5390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDRO45357163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
000076T31Medicare PIN
S49093Medicare UPIN