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NPI Code Detail

MEDICARE: MS. TAMITRA SHERELL PANNELL

MEDICARE: MS. TAMITRA SHERELL PANNELL
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerEL33456NH
2104100000XSocial Worker52163TX

General Provider Information

NPI Number : 1528883824
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. TAMITRA SHERELL PANNELL
Provider Business Mailing Address
First Line : 6255 W SUNSET BLVD FL 21
Second Line :
City : LOS ANGELES
State : CA
Zip : 90028-7422
Country : US
Telephone Number : 323-860-5200
Fax Number :
Provider Business Practice Location Address
First Line : 2053 MATADOR RANCH RD
Second Line :
City : FORT WORTH
State : TX
Zip : 76134-4178
Country : US
Telephone Number : 682-888-7990
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/21/2024
Last Update Date : 03/20/2026

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Directions to “ MS. TAMITRA SHERELL PANNELL ” Practice Location

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