Provider Demographics
NPI:1306449905
Name:SHOULDICE, KARINAGRACE ANDAYA (LPN)
Entity type:Individual
Prefix:
First Name:KARINAGRACE
Middle Name:ANDAYA
Last Name:SHOULDICE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8310 CARRBRIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-1812
Mailing Address - Country:US
Mailing Address - Phone:360-348-2999
Mailing Address - Fax:
Practice Address - Street 1:1838 GREENE TREE RD STE 260
Practice Address - Street 2:
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-7108
Practice Address - Country:US
Practice Address - Phone:410-486-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5238810164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD34278428OtherHEALTH INSURANCE