Active NPI
Shepherdhealthcare System,LLC
- Family Nurse Practitioner
- Laurel, MD
National Provider Identifier
1629823646
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- Legal business name
- SHEPHERDHEALTHCARE SYSTEM,LLC
- Practice address
- 312 Marshall Ave Ste 1010
Laurel, MD 20707-4861 - Phone
- (410) 934-4813
- Fax
- (410) 934-4815
- NPI assigned
- Apr 22, 2024
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Foluke O Ajuwon, DNP/CRNP
- Title
- Provider
- Phone
- (240) 938-4333
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | Primary |
Addresses
Primary practice location
312 Marshall Ave Ste 1010
Laurel, MD 20707-4861
Mailing address
15320 Old Frederick Rd
Woodbine, MD 21797-8748
Phone (240) 938-4333
Other names 1
- ShepherdCare Wellness Clinic
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in DC
Enrollment records 1
National Provider Directory
National Provider DirectoryLocations
312 Marshall Ave
Ste 1010
Laurel, MD 20707
Phone (410) 934-4813
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1713744000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1715904000000",
"number": "1629823646",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15320 OLD FREDERICK RD",
"city": "WOODBINE",
"state": "MD",
"postal_code": "217978748",
"telephone_number": "240-938-4333",
"fax_number": "410-934-4815"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "312 MARSHALL AVE STE 1010",
"city": "LAUREL",
"state": "MD",
"postal_code": "207074861",
"telephone_number": "410-934-4813",
"fax_number": "410-934-4815"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "SHEPHERDHEALTHCARE SYSTEM,LLC",
"organizational_subpart": "NO",
"enumeration_date": "2024-04-22",
"last_updated": "2024-05-17",
"certification_date": "2024-05-17",
"status": "A",
"authorized_official_last_name": "AJUWON",
"authorized_official_first_name": "FOLUKE",
"authorized_official_middle_name": "O",
"authorized_official_title_or_position": "PROVIDER",
"authorized_official_telephone_number": "240-938-4333",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "DNP/CRNP"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Nurse Practitioner, Family",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "ShepherdCare Wellness Clinic",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "ShepherdCare Wellness Clinic",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Laurel, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.