Provider Demographics
NPI:1811735574
Name:BEHARIE, SHALE
Entity type:Individual
Prefix:
First Name:SHALE
Middle Name:
Last Name:BEHARIE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10624 ASHFORD CIR
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20603-3202
Mailing Address - Country:US
Mailing Address - Phone:520-343-0934
Mailing Address - Fax:
Practice Address - Street 1:11110 MALL CIR
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20603-1800
Practice Address - Country:US
Practice Address - Phone:301-705-8383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-17
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD3019152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist