Healthcare Provider Details

I. General information

NPI: 1659699254
Provider Name (Legal Business Name): SHEANITA R HOWARD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2010
Last Update Date: 06/05/2024
Certification Date: 06/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1460 RITCHIE HWY STE 209
ARNOLD MD
21012-2741
US

IV. Provider business mailing address

1460 RITCHIE HIGHWAY ST 209
ARNOLD MD
21012
US

V. Phone/Fax

Practice location:
  • Phone: 410-789-7337
  • Fax: 410-349-1107
Mailing address:
  • Phone: 410-789-7337
  • Fax: 410-349-1107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberD0076289
License Number StateMD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier114350600
Identifier TypeMEDICAID
Identifier StateMD
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: