Healthcare Provider Details

I. General information

NPI: 1750294724
Provider Name (Legal Business Name): BLAIR SHELDON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 MANCHESTER RD
MANCHESTER MD
21102-1850
US

IV. Provider business mailing address

168 ALYMER CT
WESTMINSTER MD
21157-6361
US

V. Phone/Fax

Practice location:
  • Phone: 410-861-0066
  • Fax:
Mailing address:
  • Phone: 443-600-4047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLGP18548
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: