Individual
SHELLISE JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1703 E 29TH ST, BALTIMORE, MD 21218-3745
(443) 869-6882
Mailing address
703 MACDILL RD, MIDDLE RIVER, MD 21220-3794
(443) 310-8579
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
30AL3875
MD
Other
Enumeration date
01/23/2021
Last updated
01/23/2021
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