Shady Grove Andrology Center LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

SHADY GROVE ANDROLOGY CENTER LLC

Practice address

9600 Blackwell Rd Ste 500
Rockville, MD 20850-3783

Phone

(301) 340-1188

Fax

(301) 340-1612

NPI assigned

Apr 4, 2007

Organization subpart

Yes

Parent organization

SHADY GROVE FERTILITY RSCAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Shelly Shapiro

Title

Chief Financial Officer

Phone

(301) 545-1407

Specialties & licenses 2

Addresses

Other names 1

• Michael J. Tucker, PhD Other name

Part of

Shady Grove Fertility Reproductive Science Center

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1175644800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1522368000000",
    "number": "1487776274",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9600 BLACKWELL RD STE 500",
            "city": "ROCKVILLE",
            "state": "MD",
            "postal_code": "208503783",
            "telephone_number": "301-340-1188",
            "fax_number": "301-340-1612"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9600 BLACKWELL RD STE 500",
            "city": "ROCKVILLE",
            "state": "MD",
            "postal_code": "208503783",
            "telephone_number": "301-340-1188",
            "fax_number": "301-340-1612"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHADY GROVE ANDROLOGY CENTER LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SHADY GROVE FERTILITY RSC",
        "enumeration_date": "2007-04-04",
        "last_updated": "2018-03-30",
        "status": "A",
        "authorized_official_last_name": "SHAPIRO",
        "authorized_official_first_name": "SHELLY",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "301-545-1407"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "MO",
            "license": "7629",
            "primary": false
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Michael J. Tucker, PhD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Haifa Aljanabi Shaban, M.D.
• Hera Shabiu
• Grace Shadid
• Joyce Shadid
• Shady Grove Adventist Nursing & Rehabilitation Center Inc
• Shady Grove Anesthesia Associate LLC
• Shady Grove Center for Preimplantation Genetics
• Shady Grove Children'S Gad, LLC
• Shady Grove Children'S Gad, LLC
• Shady Grove Children'S Surgery Center, LLC

• Clinical Medical Laboratory in Rockville, MD
• Providers in Rockville, MD by specialty
• Clinical Medical Laboratory in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.