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SHADY GROVE DERMATOLOGY
NPI 1790177210
Specialist in Rockville, MD

Active since February 20, 2015CLIA 21D2112261 · Certificate of Compliance
15245 SHADY GROVE RD, SUITE 370, ROCKVILLE, MD 20850(240) 246-7417 Get Directions Write a Review

NPPES record last updated: March 5, 2024. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Shady Grove Dermatology NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SHADY GROVE DERMATOLOGY (NPI 1790177210), doing business as Shady Grove Dermatology, Llc, is a healthcare organization registered as a specialist in Rockville, Maryland and active in the NPI registry since February 2015. The organization holds a CLIA Certificate of Compliance certificate valid through December 1, 2027 and lists Sandee Hall Davidson, Business Consultant, as its authorized official.

NPPES Registry Identity

NPI1790177210
Entity TypeOrganization
Primary Taxonomy174400000X
Legal Business NameSHADY GROVE DERMATOLOGY
Location Address15245 SHADY GROVE RD, SUITE 370Rockville, MD 20850-3222
Mailing Address15245 Shady Grove Rd, Suite 370Rockville, MD 20850-3222 · (240) 246-7417
Phone(240) 246-7417
Organization SubpartNo
Authorized OfficialSandee Hall DavidsonBusiness Consultant · (240) 246-7417
Enumeration DateFebruary 20, 2015
Last NPPES UpdateMarch 5, 2024
NPPES CertifiedFebruary 26, 2024
✔ NPI 1790177210 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtySpecialistOther Service Providers
Taxonomy Code174400000X
License✔ Licensed in MD · D0028453
Definition
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.
Also ListedClinic/Center · Medical SpecialtyTaxonomy 261QM2500X
15245 SHADY GROVE RD, Rockville, MD 20850
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Other Names 1

Former Legal Business NameShady Grove Dermatology, Llc

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Compliance 21D2112261

Shady Grove Dermatology, LLC · Rockville, MD
Active · expires Dec 1, 2027
CLIA Number21D2112261
Laboratory TypePhysician Office
Certificate Effective DateDecember 2, 2025
Certificate Expiration DateDecember 1, 2027
Laboratory DirectorJosef K. Yeager
Laboratory Phone(240) 246-7417
Laboratory LocationShady Grove Dermatology, LLC15245 Shady Grove Road, Suite 370, Rockville, MD 20850
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

AMY BETH MORELLO MA, CCC-SLP
Speech-Language Pathologist
15245 SHADY GROVE RD, STE 110
ROCKVILLE, MD 20850
Montgomery County (301) 208-3210
WASHINGTON VASCULAR SPECIALISTS OF PG COUNTY
Internal Medicine (Cardiovascular Disease)
15245 SHADY GROVE RD, SUIT 325
ROCKVILLE, MD 20850
Montgomery County (301) 891-2500
AMBULATORY PLASTIC SURGERY CENTER ASSOCIATES, CHARTERED
Plastic Surgery
15245 SHADY GROVE RD, SUITE 155
ROCKVILLE, MD 20850
Montgomery County (240) 912-4708
RAVI PASSI MD
Internal Medicine
15245 SHADY GROVE RD, SUITE 130
ROCKVILLE, MD 20850
Montgomery County (301) 527-1650
MS. DEBRA FRIEDMAN BIEBER LCSW-C
Social Worker (Clinical)
15245 SHADY GROVE RD, SUITE C100
ROCKVILLE, MD 20850
Montgomery County (301) 417-2652
AMBULATORY PLASTIC SURGERY CENTER ASSOCIATES, CHARTERED
Clinic/Center (Ambulatory Surgical)
15245 SHADY GROVE RD, SUITE 155
ROCKVILLE, MD 20850
Montgomery County (240) 912-4708
MS. VERA RUTH REUBLINGER ARNP
Nurse Practitioner (Adult Health)
15245 SHADY GROVE RD, SUITE 130
ROCKVILLE, MD 20850
Montgomery County (301) 527-1650
CORI ANN BORTNEM CCC-SLP
Speech-Language Pathologist
15245 SHADY GROVE RD
ROCKVILLE, MD 20850
Montgomery County (301) 208-3210

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Shady Grove Dermatology's NPI number?

The NPI number for Shady Grove Dermatology is 1790177210. It was assigned to this organization in the NPPES registry on February 20, 2015. The provider was formerly known as Shady Grove Dermatology, LLC.

Where is Shady Grove Dermatology located?

Shady Grove Dermatology is located at 15245 Shady Grove Rd Suite 370, Rockville, MD 20850. The listed phone number is (240) 246-7417.

What is Shady Grove Dermatology's specialty?

The primary specialty registered for this NPI is Specialist with taxonomy code 174400000X.

Does Shady Grove Dermatology hold a CLIA laboratory certificate?

Yes. A Certificate of Compliance (number 21D2112261) is associated with this NPI, valid through December 1, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Shady Grove Dermatology was last updated on March 5, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.