Healthcare Provider Details

I. General information

NPI: 1922364322
Provider Name (Legal Business Name): DANISHA SHAVONNE MCCALL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2012
Last Update Date: 08/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4199 GATEWAY BLVD
NEWBURGH IN
47630-8940
US

IV. Provider business mailing address

PO BOX 637273
CINCINNATI OH
45263-7273
US

V. Phone/Fax

Practice location:
  • Phone: 812-842-4108
  • Fax: 812-842-4227
Mailing address:
  • Phone: 812-842-4550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA136503
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberA136503
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberA136503
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number01079674A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: