Healthcare Provider Details

I. General information

NPI: 1154240125
Provider Name (Legal Business Name): MRS. SHAYLAH MICKENS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

722 S BROADWAY UNIT 200
BALTIMORE MD
21231-3481
US

IV. Provider business mailing address

722 S BROADWAY UNIT 200
BALTIMORE MD
21231-3481
US

V. Phone/Fax

Practice location:
  • Phone: 443-597-9521
  • Fax:
Mailing address:
  • Phone: 443-597-9521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: