Active NPI
Ita M Shu
- Home Health Aide
- Glenn Dale, MD
National Provider Identifier
1720840382
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Home Health Aide
- License
- HHA200003055
- Practice address
- 10712 Marietta St
Glenn Dale, MD 20769-9405 - Phone
- (240) 510-4293
- NPI assigned
- Jan 29, 2024
- 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 |
|---|---|---|---|---|
| Home Health Aide | 374U00000X | HHA200003055 | DC | Primary |
Addresses
Primary practice location
10712 Marietta St
Glenn Dale, MD 20769-9405
Mailing address
10712 Marietta St
Glenn Dale, MD 20769-9405
Phone (240) 510-4293
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 |
|---|---|---|---|
| HHA200003055 | DC | MD | Home Health Aide |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1706486400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1738540800000",
"number": "1720840382",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10712 MARIETTA ST",
"city": "GLENN DALE",
"state": "MD",
"postal_code": "207699405",
"telephone_number": "240-510-4293"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10712 MARIETTA ST",
"city": "GLENN DALE",
"state": "MD",
"postal_code": "207699405",
"telephone_number": "240-510-4293"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHU",
"first_name": "ITA",
"middle_name": "M",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-01-29",
"last_updated": "2025-02-03",
"certification_date": "2025-02-03",
"status": "A"
},
"taxonomies": [
{
"code": "374U00000X",
"taxonomy_group": "",
"desc": "Home Health Aide",
"state": "DC",
"license": "HHA200003055",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Glenn Dale, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.