Healthcare Provider Details

I. General information

NPI: 1598223547
Provider Name (Legal Business Name): SHEREENA SORRELL-WHITAKER FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHEREENA SORRELL NP-C , FNP-BC

II. Dates (important events)

Enumeration Date: 03/08/2019
Last Update Date: 03/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 E 25TH ST
BALTIMORE MD
21218-5213
US

IV. Provider business mailing address

9505 SIDE BROOK RD APT 201
OWINGS MILLS MD
21117-7640
US

V. Phone/Fax

Practice location:
  • Phone: 410-558-0019
  • Fax: 410-366-2108
Mailing address:
  • Phone: 410-440-1765
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR111744
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: