Provider Demographics
NPI:1629855531
Name:MALDONADO, SHIELA ALIZON (LGPC)
Entity type:Individual
Prefix:
First Name:SHIELA
Middle Name:ALIZON
Last Name:MALDONADO
Suffix:
Gender:F
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 N ARMISTEAD ST APT 201
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22312-3411
Mailing Address - Country:US
Mailing Address - Phone:787-689-1034
Mailing Address - Fax:
Practice Address - Street 1:903 BRIGHTSEAT RD
Practice Address - Street 2:
Practice Address - City:LANDOVER
Practice Address - State:MD
Practice Address - Zip Code:20785-4725
Practice Address - Country:US
Practice Address - Phone:301-333-2980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-13
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225500000X
MDLGP16313101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No225500000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/Technologist