Provider Demographics
NPI:1366915928
Name:GARRICKS, SHANIEL
Entity type:Individual
Prefix:
First Name:SHANIEL
Middle Name:
Last Name:GARRICKS
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 1:3522 PEAR TREE CT
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906-2562
Mailing Address - Country:US
Mailing Address - Phone:301-316-8465
Mailing Address - Fax:
Practice Address - Street 1:1822 ONTARIO PL NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-2109
Practice Address - Country:US
Practice Address - Phone:202-441-4694
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-07
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDCNA20184293374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide