Provider Demographics
NPI:1447447974
Name:SOLOMON, SHOBHA (MS, FNP)
Entity type:Individual
Prefix:
First Name:SHOBHA
Middle Name:
Last Name:SOLOMON
Suffix:
Gender:F
Credentials:MS, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2040 MAYFLOWER DR
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20905-5563
Mailing Address - Country:US
Mailing Address - Phone:301-367-1533
Mailing Address - Fax:
Practice Address - Street 1:9318 GAITHER RD STE 245
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-1423
Practice Address - Country:US
Practice Address - Phone:301-367-1533
Practice Address - Fax:301-527-0703
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-28
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR120906363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD454006900Medicaid