Healthcare Provider Details

I. General information

NPI: 1295672293
Provider Name (Legal Business Name): NICOLE SHELL PSYCHIATRY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5430 CAMPBELL BLVD STE 107
WHITE MARSH MD
21162-5503
US

IV. Provider business mailing address

5430 CAMPBELL BLVD STE 107
WHITE MARSH MD
21162-5503
US

V. Phone/Fax

Practice location:
  • Phone: 443-720-3902
  • Fax:
Mailing address:
  • Phone: 443-720-3902
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: NICOLE L SHELL
Title or Position: OWNER
Credential: PMHNP
Phone: 410-800-6186