Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker |
NPI | 1003475419 |
---|---|
Provider Name | Shayna Pauline Church |
First Address | Easton, MD 21601-3525 |
Second Address | Easton, MD 21601-3525 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2019 |
Last Update Date | 10/07/2019 |