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General NPI Number Information
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NPI Number | 1831634351
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Entity Type | Individual
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Provider Name | MRS. AMANDA SHIELDS
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Gender | Female
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Dates
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Enumeration Date | 12/20/2016
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Last Update Date | 02/26/2020
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Provider Practice Location Address
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Address Line | 7175 COLUMBIA GATEWAY DR SUITE A
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City | COLUMBIA
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State | MD
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Zip | 21046-2534
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Country | US
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Telephone | 888-344-5977
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Fax |
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Provider Business Mailing Address
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Address Line | 417 MACINTOSH CIR
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City | JOPPA
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State | MD
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Zip | 21085-5400
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Country | US
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Telephone | 702-374-8168
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-15-11476
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License Number State |
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