Provider Demographics
NPI:1982299632
Name:CAMPBELL, SHAREEN NICOLE (PMHNP)
Entity Type:Individual
Prefix:
First Name:SHAREEN
Middle Name:NICOLE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9055 CHEVROLET DR STE 205
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-4000
Mailing Address - Country:US
Mailing Address - Phone:410-465-5451
Mailing Address - Fax:
Practice Address - Street 1:20 PAULA PL
Practice Address - Street 2:
Practice Address - City:ROSEDALE
Practice Address - State:MD
Practice Address - Zip Code:21237-4547
Practice Address - Country:US
Practice Address - Phone:443-680-0361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-04
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR196504363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0000Medicaid