Basic Information
| Provider Information | |||||||||
| NPI: | 1659998821 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | POWELL | ||||||||
| FirstName: | SHARONICA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11350 MCCORMICK RD STE 501 | ||||||||
| Address2: | EXECUTIVE PLAZA 1 | ||||||||
| City: | HUNT VALLEY | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21031 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7039148000 | ||||||||
| FaxNumber: | 4103291054 | ||||||||
| Practice Location | |||||||||
| Address1: | 1218 N BONNIE BRAE ST | ||||||||
| Address2: | |||||||||
| City: | DENTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 762015486 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8173488600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/02/2020 | ||||||||
| LastUpdateDate: | 07/02/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.