Provider Demographics
NPI:1023670627
Name:STOTTS, SHANELL LYNN
Entity type:Individual
Prefix:
First Name:SHANELL
Middle Name:LYNN
Last Name:STOTTS
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 1:701 BRANDYWINE ST SE APT 301
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20032-3551
Mailing Address - Country:US
Mailing Address - Phone:202-878-5730
Mailing Address - Fax:
Practice Address - Street 1:701 BRANDYWINE ST SE APT 301
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-3551
Practice Address - Country:US
Practice Address - Phone:202-878-5730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-03
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC190702001384374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide