Provider Demographics
NPI:1417190638
Name:TILLMAN, SHEENA M
Entity Type:Individual
Prefix:
First Name:SHEENA
Middle Name:M
Last Name:TILLMAN
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 1:10300 LITTLE PATUXENT PKWY
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-3341
Mailing Address - Country:US
Mailing Address - Phone:410-884-6500
Mailing Address - Fax:410-884-0873
Practice Address - Street 1:10300 LITTLE PATUXENT PKWY
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3341
Practice Address - Country:US
Practice Address - Phone:410-884-6500
Practice Address - Fax:410-884-0873
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-17
Last Update Date:2009-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
No156FX1100XEye and Vision Services ProvidersTechnician/TechnologistOphthalmic