Provider Demographics
NPI:1639984693
Name:SHURI, DESTINY (DS)
Entity type:Individual
Prefix:
First Name:DESTINY
Middle Name:
Last Name:SHURI
Suffix:
Gender:
Credentials:DS
Other - Prefix:MISS
Other - First Name:DESTINY
Other - Middle Name:
Other - Last Name:SHURI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13912 MARY ANN DR UPPR MARLBORO
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-8530
Mailing Address - Country:US
Mailing Address - Phone:240-907-7346
Mailing Address - Fax:240-907-7346
Practice Address - Street 1:13912 MARY ANN DR UPPR MARLBORO
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-8530
Practice Address - Country:US
Practice Address - Phone:240-907-7346
Practice Address - Fax:240-907-7346
Is Sole Proprietor?:No
Enumeration Date:2025-02-07
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMD-102757742723747P1801X
374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant