Provider Demographics
NPI:1154721934
Name:BLANDON, SHANIKA
Entity type:Individual
Prefix:
First Name:SHANIKA
Middle Name:
Last Name:BLANDON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 KING FARM BLVD
Mailing Address - Street 2:140
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-5872
Mailing Address - Country:US
Mailing Address - Phone:301-977-8695
Mailing Address - Fax:
Practice Address - Street 1:404 KING FARM BLVD
Practice Address - Street 2:#140
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-5872
Practice Address - Country:US
Practice Address - Phone:301-977-8695
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-28
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD2733237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist