Healthcare Provider Details

I. General information

NPI: 1629855531
Provider Name (Legal Business Name): SHIELA ALIZON MALDONADO LGPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2023
Last Update Date: 04/04/2025
Certification Date: 04/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

903 BRIGHTSEAT RD
LANDOVER MD
20785-4725
US

IV. Provider business mailing address

424 N ARMISTEAD ST APT 201
ALEXANDRIA VA
22312-3411
US

V. Phone/Fax

Practice location:
  • Phone: 301-333-2980
  • Fax:
Mailing address:
  • Phone: 787-689-1034
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLGP16313
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code225500000X
TaxonomyRespiratory/Developmental/Rehabilitative Specialist/Technologist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: