Healthcare Provider Details

I. General information

NPI: 1356245419
Provider Name (Legal Business Name): SHIELD SUPPORT BROKER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

148 S HARTLEY ST
YORK PA
17401-3744
US

IV. Provider business mailing address

148 S HARTLEY ST
YORK PA
17401-3744
US

V. Phone/Fax

Practice location:
  • Phone: 717-841-2592
  • Fax:
Mailing address:
  • Phone: 717-841-2592
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: RASHIN OSMAN
Title or Position: PRESIDENT
Credential: LSW
Phone: 717-841-2592