Provider Demographics
NPI:1033822317
Name:NICHOLS, SHANA NICOLE (PMHNP)
Entity Type:Individual
Prefix:MS
First Name:SHANA
Middle Name:NICOLE
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7933 ANNAPOLIS RD # 1054
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-1309
Mailing Address - Country:US
Mailing Address - Phone:410-705-4422
Mailing Address - Fax:205-855-0617
Practice Address - Street 1:8338 VETERANS HWY STE 204A
Practice Address - Street 2:
Practice Address - City:MILLERSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21108-2603
Practice Address - Country:US
Practice Address - Phone:410-705-4422
Practice Address - Fax:205-855-0617
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-02
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR213445363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health