Provider Demographics
NPI:1861968562
Name:DOLBY, SHAUNNA SHEREE (FNP)
Entity type:Individual
Prefix:
First Name:SHAUNNA
Middle Name:SHEREE
Last Name:DOLBY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:SHAUNNA
Other - Middle Name:SHEREE
Other - Last Name:DOLBY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP
Mailing Address - Street 1:5801 ALLENTOWN RD STE 502
Mailing Address - Street 2:
Mailing Address - City:CAMP SPRINGS
Mailing Address - State:MD
Mailing Address - Zip Code:20746-4653
Mailing Address - Country:US
Mailing Address - Phone:240-427-1630
Mailing Address - Fax:
Practice Address - Street 1:5801 ALLENTOWN RD STE 502
Practice Address - Street 2:
Practice Address - City:CAMP SPRINGS
Practice Address - State:MD
Practice Address - Zip Code:20746-4653
Practice Address - Country:US
Practice Address - Phone:240-427-1630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-19
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR190159207Q00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner