Provider Demographics
NPI:1881336477
Name:DACOSTA, SHEVEL SANTANYA (MD)
Entity type:Individual
Prefix:MS
First Name:SHEVEL
Middle Name:SANTANYA
Last Name:DACOSTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:15245 SHADY GROVE RD STE 340
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-7201
Mailing Address - Country:US
Mailing Address - Phone:301-869-9776
Mailing Address - Fax:301-417-4947
Practice Address - Street 1:2639 CONNECTICUT AVE NW STE C100
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20008-1593
Practice Address - Country:US
Practice Address - Phone:202-588-1878
Practice Address - Fax:301-417-4948
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-12
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
390200000X
DCMD600004187207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program