1396247920 NPI number — TALIA SHAKIRA JOHNSON MSOT,OTRL

Table of content: TALIA SHAKIRA JOHNSON MSOT,OTRL (NPI 1396247920)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396247920 NPI number — TALIA SHAKIRA JOHNSON MSOT,OTRL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOHNSON
Provider First Name:
TALIA
Provider Middle Name:
SHAKIRA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSOT,OTRL
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JOHNSON
Provider Other First Name:
TALIA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1396247920
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/28/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 500
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROOKEVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20833-0500
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-984-2011
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1718 BELMONT AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WINDSOR MILL
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21244-2552
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-200-5294
Provider Business Practice Location Address Fax Number:
443-348-5970
Provider Enumeration Date:
02/28/2018

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225XP0019X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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