Provider Demographics
NPI:1326412826
Name:SIVELS, SHARITA
Entity Type:Individual
Prefix:
First Name:SHARITA
Middle Name:
Last Name:SIVELS
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 1:5800 BETSY CIR
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20601-3301
Mailing Address - Country:US
Mailing Address - Phone:410-934-0581
Mailing Address - Fax:410-834-1217
Practice Address - Street 1:5800 BETSY CIR
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20601-3301
Practice Address - Country:US
Practice Address - Phone:301-609-9887
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-20
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC8368101YM0800X
MDLGP6716101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD589561800Medicaid