Healthcare Provider Details

I. General information

NPI: 1326307950
Provider Name (Legal Business Name): SHEILA ROLANDA GAMBOA BOLANOS NP-C, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2012
Last Update Date: 11/30/2025
Certification Date: 11/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2391 GREENSPRING DR
TIMONIUM MD
21093-3166
US

IV. Provider business mailing address

13 HEWETSON CT
LUTHERVILLE TIMONIUM MD
21093-7401
US

V. Phone/Fax

Practice location:
  • Phone: 410-847-3000
  • Fax:
Mailing address:
  • Phone: 469-638-4278
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP500002495
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95016105
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR255962
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: