Provider Demographics
NPI:1265837835
Name:SOMO, SHEILA A
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:A
Last Name:SOMO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3410 DODGE PARK RD APT T033410
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20785-2023
Mailing Address - Country:US
Mailing Address - Phone:240-615-6011
Mailing Address - Fax:
Practice Address - Street 1:10424 FLORAL DR
Practice Address - Street 2:10424 FLORAL DRIVE
Practice Address - City:ADELPHI
Practice Address - State:MD
Practice Address - Zip Code:20783-1226
Practice Address - Country:US
Practice Address - Phone:240-615-6011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-24
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLG200001758104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker