Healthcare Provider Details

I. General information

NPI: 1437586104
Provider Name (Legal Business Name): SHIELA DIANE DYE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2013
Last Update Date: 09/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4134 E JOPPA RD SUITE 202
BALTIMORE MD
21236-2284
US

IV. Provider business mailing address

4134 E JOPPA RD SUITE 202
BALTIMORE MD
21236-2284
US

V. Phone/Fax

Practice location:
  • Phone: 410-248-9800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberR045658
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: