=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346813649
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHAREN BRENDA TAYLOR WHITE PSYCHIATRIC NURSE PR
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/23/2021
-----------------------------------------------------
Last Update Date | 09/09/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13908 OWINGS AVE
-----------------------------------------------------
City | BRANDYWINE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20613-5919
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-266-1241
-----------------------------------------------------
Fax | 301-782-3213
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13908 OWINGS AVE
-----------------------------------------------------
City | BRANDYWINE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20613-5919
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-266-1241
-----------------------------------------------------
Fax | 301-782-3213
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0804X
-----------------------------------------------------
Taxonomy Name | Child & Adolescent Psychiatry Physician
-----------------------------------------------------
License Number | R167277
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------