Shady Grove Dermatology
NPI 1790177210 · Specialist · Rockville, MD
Enrolled with Medicare as Part B Supplier - Clinic/Group Practice · source: CMS PECOS Public Provider Enrollment (2026.04.01)
Shady Grove Dermatology is a Specialist organization in Rockville, MD (NPI 1790177210).
Provider details
- NPI number
- 1790177210
- Entity type
- Organization
- Primary specialty
- SpecialistOther Service Providers
- Organization subpart
- No
- Authorized official
- Sandee Davidson, Business Consultant(240) 246-7417
Specialties & taxonomies
Other Service Providers
- Medical Specialty Clinic/Center261QM2500X
Ambulatory Health Care Facilities
Profile Score
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
11 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
Mailing address
Other names (DBA / former)
- Former legal business name
- Shady Grove Dermatology, LLC
Registry dates
- Enumerated
- 2015-02-20
- Last updated
- 2024-03-05
- Certified
- 2024-02-26
Frequently asked questions
- What is Shady Grove Dermatology's NPI number?
- Shady Grove Dermatology's National Provider Identifier (NPI) is 1790177210, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is Shady Grove Dermatology?
- Shady Grove Dermatology is classified in the NPPES registry as Specialist (Other Service Providers).
- Where is Shady Grove Dermatology located?
- Shady Grove Dermatology's practice location on file with NPPES is 15245 Shady Grove Rd, Rockville, MD 20850-3222.
- What is Shady Grove Dermatology's phone number?
- The practice phone number listed in the NPPES registry for Shady Grove Dermatology is (240) 246-7417.
- Does Shady Grove Dermatology accept Medicare?
- Shady Grove Dermatology is approved to bill Medicare according to CMS PECOS enrollment data (2026.04.01). Confirm current participation with the provider before scheduling.
- Who is the authorized official for Shady Grove Dermatology?
- The authorized official listed on Shady Grove Dermatology's NPPES record is Sandee Davidson, Business Consultant. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is Shady Grove Dermatology's NPI active?
- Yes — Shady Grove Dermatology's NPI (1790177210) is active in the NPPES registry as of the last update on 2024-03-05.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.