Provider Demographics
NPI:1720777501
Name:DYER, SHILLINE
Entity type:Individual
Prefix:
First Name:SHILLINE
Middle Name:
Last Name:DYER
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 1:1140 3RD ST NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-6274
Mailing Address - Country:US
Mailing Address - Phone:301-836-2519
Mailing Address - Fax:301-576-8422
Practice Address - Street 1:1140 3RD ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-6274
Practice Address - Country:US
Practice Address - Phone:301-836-2519
Practice Address - Fax:301-576-8422
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-05
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332U00000XSuppliersHome Delivered Meals