Healthcare Provider Details

I. General information

NPI: 1710797998
Provider Name (Legal Business Name): SHAKIA MIXON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2025
Last Update Date: 12/21/2025
Certification Date: 12/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 YORK RD STE 800
LUTHERVILLE TIMONIUM MD
21093-6011
US

IV. Provider business mailing address

1301 YORK RD STE 800
LUTHERVILLE TIMONIUM MD
21093-6011
US

V. Phone/Fax

Practice location:
  • Phone: 980-699-5320
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR240365
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberR240365
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: