Provider Demographics
NPI:1194278325
Name:BEACHUM, SHAVONNE
Entity type:Individual
Prefix:DR
First Name:SHAVONNE
Middle Name:
Last Name:BEACHUM
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 1:1675 MEADE VILLAGE CIR
Mailing Address - Street 2:APT 368
Mailing Address - City:SEVERN
Mailing Address - State:MD
Mailing Address - Zip Code:21144-2409
Mailing Address - Country:US
Mailing Address - Phone:410-841-9416
Mailing Address - Fax:
Practice Address - Street 1:1675 MEADE VILLAGE CIR
Practice Address - Street 2:APT 368
Practice Address - City:SEVERN
Practice Address - State:MD
Practice Address - Zip Code:21144-2409
Practice Address - Country:US
Practice Address - Phone:410-841-9416
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-23
Last Update Date:2016-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant