Provider Demographics
NPI:1861294803
Name:SHODE, JAYLEN JOB
Entity type:Individual
Prefix:
First Name:JAYLEN
Middle Name:JOB
Last Name:SHODE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 BURNT MILLS AVE
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20901-4504
Mailing Address - Country:US
Mailing Address - Phone:202-528-1207
Mailing Address - Fax:
Practice Address - Street 1:500 BURNT MILLS AVE
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20901-4504
Practice Address - Country:US
Practice Address - Phone:202-528-1207
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-27
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker