NPIMap

Individual provider Active NPI

Shonnell Shelton

  • Clinical Social Worker
  • Laurel, MD
National Provider Identifier
1679152441
Registry record updated Sep 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
21094 Issued in MD
Practice address
9811 Mallard Dr Ste 203
Laurel, MD 20708-3199
Phone
(301) 778-8835
NPI assigned
Apr 7, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 21, 2021

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X
Social Worker 104100000X LG50081504 DC
Social Worker 104100000X 21094 MD
Clinical Social Worker 1041C0700X 21094 MD Primary

Addresses

Primary practice location

9811 Mallard Dr Ste 203
Laurel, MD 20708-3199

Mailing address

13603 Avebury Dr Apt 12
Laurel, MD 20708-3439
Phone (240) 918-0861

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL rise-family.org

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)
Enrolled

State licenses

LicenseStateTypeSpecialty
LG50081504DCMDSocial Worker
21094MDMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
R.I.S.E Family Services LLC Past Accepting new patients
R.I.S.E Family Services LLC Past Accepting new patients
R.I.S.E Family Services LLC Past Accepting new patients
R.I.S.E Family Services LLC Past Accepting new patients

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1617753600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632182400000",
    "number": "1679152441",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13603 AVEBURY DR APT 12",
            "city": "LAUREL",
            "state": "MD",
            "postal_code": "207083439",
            "telephone_number": "240-918-0861"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9811 MALLARD DR STE 203",
            "city": "LAUREL",
            "state": "MD",
            "postal_code": "207083199",
            "telephone_number": "301-778-8835"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHELTON",
        "first_name": "SHONNELL",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-04-07",
        "last_updated": "2021-09-21",
        "certification_date": "2021-09-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "DC",
            "license": "LG50081504",
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "MD",
            "license": "21094",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MD",
            "license": "21094",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "rise-family.org",
            "affiliation": "N",
            "endpointDescription": "website",
            "address_1": "9811 Mallard Dr Ste 203",
            "city": "Laurel",
            "state": "MD",
            "country_code": "US",
            "postal_code": "207083199",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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 Sep 21, 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.

Verify at the official NPI Registry.