Healthcare Provider Details

I. General information

NPI: 1194286757
Provider Name (Legal Business Name): WENDY CHRISTINE SHEPARD PMHCNS-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2019
Last Update Date: 03/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1821 PORTAL ST STE A
BALTIMORE MD
21224-6541
US

IV. Provider business mailing address

1821 PORTAL ST STE A
BALTIMORE MD
21224-6541
US

V. Phone/Fax

Practice location:
  • Phone: 410-631-6140
  • Fax: 410-633-4210
Mailing address:
  • Phone: 410-631-6140
  • Fax: 410-633-4210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberR080958
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: