Provider Demographics
NPI:1972301422
Name:SOPPO, SHILLING MBU
Entity type:Individual
Prefix:
First Name:SHILLING
Middle Name:MBU
Last Name:SOPPO
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 1:7509 BUCHANAN ST APT 319
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20784-2381
Mailing Address - Country:US
Mailing Address - Phone:202-839-6863
Mailing Address - Fax:
Practice Address - Street 1:7509 BUCHANAN ST APT 319
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20784-2381
Practice Address - Country:US
Practice Address - Phone:202-839-6863
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-03
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide