Provider Demographics
NPI:1598223547
Name:SORRELL-WHITAKER, SHEREENA (FNP-BC)
Entity Type:Individual
Prefix:
First Name:SHEREENA
Middle Name:
Last Name:SORRELL-WHITAKER
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:SHEREENA
Other - Middle Name:
Other - Last Name:SORRELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP-C , FNP-BC
Mailing Address - Street 1:9505 SIDE BROOK RD APT 201
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-7640
Mailing Address - Country:US
Mailing Address - Phone:410-440-1765
Mailing Address - Fax:
Practice Address - Street 1:107 E 25TH ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-5213
Practice Address - Country:US
Practice Address - Phone:410-558-0019
Practice Address - Fax:410-366-2108
Is Sole Proprietor?:No
Enumeration Date:2019-03-08
Last Update Date:2019-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR111744363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily