Healthcare Provider Details

I. General information

NPI: 1821709189
Provider Name (Legal Business Name): CHELSEA SHOCK DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2022
Last Update Date: 12/18/2023
Certification Date: 12/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1803 YORK RD
TIMONIUM MD
21093-5119
US

IV. Provider business mailing address

435 E BROADWAY
BEL AIR MD
21014-3203
US

V. Phone/Fax

Practice location:
  • Phone: 443-432-2767
  • Fax:
Mailing address:
  • Phone: 410-382-6125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberLJ-0010453
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR2200384
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberR2200384
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: