Provider Demographics
NPI:1790020139
Name:UMAYAM, SHEILA PEROLINA (DNP, CPNP-PC, PMHS)
Entity type:Individual
Prefix:
First Name:SHEILA
Middle Name:PEROLINA
Last Name:UMAYAM
Suffix:
Gender:F
Credentials:DNP, CPNP-PC, PMHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3901 GREENSPRING AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21211-1353
Mailing Address - Country:US
Mailing Address - Phone:443-923-7646
Mailing Address - Fax:
Practice Address - Street 1:3901 GREENSPRING AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21211-1353
Practice Address - Country:US
Practice Address - Phone:443-923-7646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-11
Last Update Date:2022-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR243071363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1530798Medicaid