Provider Demographics
NPI:1538621768
Name:POPKIN, SHAYNA JENNY (DO)
Entity type:Individual
Prefix:
First Name:SHAYNA
Middle Name:JENNY
Last Name:POPKIN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8161 MAPLE LAWN BLVD STE 430
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:MD
Mailing Address - Zip Code:20759-2571
Mailing Address - Country:US
Mailing Address - Phone:240-354-2947
Mailing Address - Fax:
Practice Address - Street 1:8161 MAPLE LAWN BLVD STE 430
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:MD
Practice Address - Zip Code:20759-2571
Practice Address - Country:US
Practice Address - Phone:240-354-2947
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-05
Last Update Date:2023-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MDH00924452084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty