Provider Demographics
NPI:1851260046
Name:MCCOMBS, SHANICE VIRTUAL
Entity type:Individual
Prefix:
First Name:SHANICE
Middle Name:VIRTUAL
Last Name:MCCOMBS
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 1:11804 PRICES DISTILLERY RD
Mailing Address - Street 2:
Mailing Address - City:DAMASCUS
Mailing Address - State:MD
Mailing Address - Zip Code:20872-1506
Mailing Address - Country:US
Mailing Address - Phone:240-903-0179
Mailing Address - Fax:
Practice Address - Street 1:3412 13TH PL SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-5033
Practice Address - Country:US
Practice Address - Phone:240-903-0179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-11-04
Last Update Date:2025-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty