Provider Demographics
NPI:1174308886
Name:SHIELDS, TYSHEA ZAAKYAH (LMSW)
Entity type:Individual
Prefix:MISS
First Name:TYSHEA
Middle Name:ZAAKYAH
Last Name:SHIELDS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4102 CRAWFORD AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-4203
Mailing Address - Country:US
Mailing Address - Phone:443-803-5820
Mailing Address - Fax:
Practice Address - Street 1:200 E BALTIMORE ST # MD21202
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-3403
Practice Address - Country:US
Practice Address - Phone:240-547-9180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-30
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD235501041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool