Healthcare Provider Details

I. General information

NPI: 1215520358
Provider Name (Legal Business Name): SHARONDA LANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2021
Last Update Date: 06/23/2023
Certification Date: 06/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5404 CATALPHA RD
BALTIMORE MD
21214-1925
US

IV. Provider business mailing address

5410 NORTHWOOD DR
BALTIMORE MD
21239-3307
US

V. Phone/Fax

Practice location:
  • Phone: 443-744-5368
  • Fax:
Mailing address:
  • Phone: 443-473-0352
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: