Healthcare Provider Details

I. General information

NPI: 1396211280
Provider Name (Legal Business Name): SHALONDA JEANINE SEWELL MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SHALONDA JEANINE SEWELL MS

II. Dates (important events)

Enumeration Date: 10/17/2018
Last Update Date: 10/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

273 CEDAR DR
MOBILE AL
36617-3951
US

IV. Provider business mailing address

273 CEDAR DR
MOBILE AL
36617-3951
US

V. Phone/Fax

Practice location:
  • Phone: 251-583-4641
  • Fax:
Mailing address:
  • Phone: 251-583-4641
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: