Provider Demographics
NPI:1235523614
Name:SHIELS, ANGELICA (PSYD)
Entity Type:Individual
Prefix:
First Name:ANGELICA
Middle Name:
Last Name:SHIELS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1509 RITCHIE HWY
Mailing Address - Street 2:F
Mailing Address - City:ARNOLD
Mailing Address - State:MD
Mailing Address - Zip Code:21012-2742
Mailing Address - Country:US
Mailing Address - Phone:410-757-2077
Mailing Address - Fax:410-757-5184
Practice Address - Street 1:1509 RITCHIE HWY
Practice Address - Street 2:F
Practice Address - City:ARNOLD
Practice Address - State:MD
Practice Address - Zip Code:21012-2742
Practice Address - Country:US
Practice Address - Phone:410-757-2077
Practice Address - Fax:410-757-5184
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-24
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05449103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical