Individual
JACQUELINE VICTORIA SHEA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
40 S DUNDALK AVE STE 400, BALTIMORE, MD 21222
(410) 220-0720
(410) 862-0150
Mailing address
6412 WESLEY LN, ELKRIDGE, MD 21075-5958
(443) 889-5513
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R192781
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
212220100
—
MD
Enumeration date
01/02/2018
Last updated
05/28/2019
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