Active NPI
Wanda Alisa Shird
- Assisted Living Facility
- Baltimore, MD
National Provider Identifier
1104416593
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Assisted Living Facility
- License
- 30AL3878
- Practice address
- 4406 Belle Ave
Baltimore, MD 21207-7645 - Phone
- (443) 523-7964
- NPI assigned
- Jan 20, 2021
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Assisted Living Facility | 310400000X | 30AL3878 | MD | Primary |
Addresses
Primary practice location
4406 Belle Ave
Baltimore, MD 21207-7645
Mailing address
4406 Belle Ave
Baltimore, MD 21207-7645
Phone (443) 523-7964
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 30AL3878 | MD | MD | Assisted Living Facility |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1611100800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1611100800000",
"number": "1104416593",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4406 BELLE AVE",
"city": "BALTIMORE",
"state": "MD",
"postal_code": "212077645",
"telephone_number": "443-523-7964"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4406 BELLE AVE",
"city": "BALTIMORE",
"state": "MD",
"postal_code": "212077645",
"telephone_number": "443-523-7964"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHIRD",
"first_name": "WANDA",
"middle_name": "ALISA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-01-20",
"last_updated": "2021-01-20",
"certification_date": "2021-01-20",
"status": "A"
},
"taxonomies": [
{
"code": "310400000X",
"taxonomy_group": "",
"desc": "Assisted Living Facility",
"state": "MD",
"license": "30AL3878",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Baltimore, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.