Healthcare Provider Details

I. General information

NPI: 1831192780
Provider Name (Legal Business Name): MS. SHEENA STRUDWICK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 07/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 LOCH RAVEN BLVD
BALTIMORE MD
21218-2108
US

IV. Provider business mailing address

2 NORMANDY SQUARE CT APT F
SILVER SPRING MD
20906-6115
US

V. Phone/Fax

Practice location:
  • Phone: 410-605-7628
  • Fax: 410-605-7691
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberR092620
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: