Active NPI
Shayla Kirondi Moore, OTR/L
- Occupational Therapist
- Waldorf, MD
National Provider Identifier
1124325253
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 04191
- Practice address
- 10713 Sourwood Ave
Waldorf, MD 20603-5752 - Phone
- (240) 475-2658
- NPI assigned
- Feb 25, 2011
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 04191 | MD | Primary |
Addresses
Primary practice location
10713 Sourwood Ave
Waldorf, MD 20603-5752
Mailing address
10713 Sourwood Ave
Waldorf, MD 20603-5752
Phone (240) 475-2658
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 |
|---|---|---|---|
| 04191 | MD | MD | Clinical Child & Adolescent Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1298592000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1298592000000",
"number": "1124325253",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10713 SOURWOOD AVE",
"city": "WALDORF",
"state": "MD",
"postal_code": "206035752",
"telephone_number": "240-475-2658"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10713 SOURWOOD AVE",
"city": "WALDORF",
"state": "MD",
"postal_code": "206035752",
"telephone_number": "240-475-2658"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOORE",
"first_name": "SHAYLA",
"middle_name": "KIRONDI",
"credential": "OTR/L",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-02-25",
"last_updated": "2011-02-25",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "MD",
"license": "04191",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Waldorf, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.