Healthcare Provider Details

I. General information

NPI: 1417455585
Provider Name (Legal Business Name): SHILLA POKUAA PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2018
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 S PHILADELPHIA BLVD
ABERDEEN MD
21001-3205
US

IV. Provider business mailing address

125 S PHILADELPHIA BLVD
ABERDEEN MD
21001-3205
US

V. Phone/Fax

Practice location:
  • Phone: 443-692-2013
  • Fax: 508-866-5102
Mailing address:
  • Phone: 443-692-2013
  • Fax: 508-866-5102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR205295
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR205295
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: