Provider Demographics
NPI:1891392627
Name:MOKOM, SHELA LUM
Entity type:Individual
Prefix:MS
First Name:SHELA
Middle Name:LUM
Last Name:MOKOM
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14806 CROSS RIVER CT
Mailing Address - Street 2:
Mailing Address - City:BURTONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20866-3104
Mailing Address - Country:US
Mailing Address - Phone:240-491-2435
Mailing Address - Fax:
Practice Address - Street 1:14806 CROSS RIVER CT
Practice Address - Street 2:
Practice Address - City:BURTONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20866-3104
Practice Address - Country:US
Practice Address - Phone:240-491-2435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-05
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC277596245Medicaid