Healthcare Provider Details

I. General information

NPI: 1760107437
Provider Name (Legal Business Name): SHEDRICK FAMILY WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2022
Last Update Date: 10/05/2022
Certification Date: 10/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7000 HARFORD RD
BALTIMORE MD
21234-7704
US

IV. Provider business mailing address

7000 HARFORD RD
BALTIMORE MD
21234-7704
US

V. Phone/Fax

Practice location:
  • Phone: 443-438-5612
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: BEATRICE SHEDRICK
Title or Position: CEO
Credential:
Phone: 443-438-5612