Healthcare Provider Details

I. General information

NPI: 1336826288
Provider Name (Legal Business Name): PRISM SHILLING MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA SHILLING

II. Dates (important events)

Enumeration Date: 07/03/2023
Last Update Date: 07/03/2023
Certification Date: 07/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2217 SAINT PAUL ST APT 3
BALTIMORE MD
21218-5974
US

IV. Provider business mailing address

7474 GREENWAY CENTER DR STE 200
GREENBELT MD
20770-3524
US

V. Phone/Fax

Practice location:
  • Phone: 770-598-8098
  • Fax:
Mailing address:
  • Phone: 240-304-3327
  • Fax: 410-609-7091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: