Provider Demographics
NPI:1336450253
Name:GUMA, SHANNAROSE (MD)
Entity type:Individual
Prefix:DR
First Name:SHANNAROSE
Middle Name:
Last Name:GUMA
Suffix:
Gender:
Credentials:MD
Other - Prefix:DR
Other - First Name:SHANNAROSE
Other - Middle Name:
Other - Last Name:NIGRELLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3290 N RIDGE RD STE 220
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-3657
Mailing Address - Country:US
Mailing Address - Phone:410-801-2273
Mailing Address - Fax:410-385-9319
Practice Address - Street 1:3290 N RIDGE RD STE 220
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-3657
Practice Address - Country:US
Practice Address - Phone:410-801-2273
Practice Address - Fax:410-385-9319
Is Sole Proprietor?:No
Enumeration Date:2010-06-25
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD899932682083B0002X
MDD0074300207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No2083B0002XAllopathic & Osteopathic PhysiciansPreventive MedicineObesity Medicine