Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Shannon Moore

Individual provider Rehabilitation Practitioner · NPI 1912439001

Shannon Moore is a Mental Health Counselor in Rosedale, Maryland. Qualified in 2022, 4 years ago. Practices as a sole proprietor. Licensed in Maryland.

Years since qualifying
4
Licensed in
MD
In the registry since
2017
Specialties on file
2

Practice location Address checks out

9627 Philadelphia Rd Ste 160
Rosedale, MD 21237-4157
Phone: (410) 780-5203
Fax: (410) 780-5205
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Professional Counselor (primary) Taxonomy 101YP2500X · Licence 16339 (MD)
Rehabilitation Practitioner Taxonomy 225400000X

Record details

NPI number1912439001
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorYes
NPI enumeratedMarch 29, 2017
Last updated in NPPESSeptember 15, 2025
Certification dateSeptember 15, 2025
Mailing address9627 Philadelphia Rd Ste 160, Rosedale, MD 21237-4157

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyMENTAL HEALTH COUNSELOR
Medical schoolOTHER
Graduated 2022 (4 years in practice)
Accepts Medicare assignment Not indicated
Practice locations2 on file with Medicare