Healthcare Provider Details

I. General information

NPI: 1144101395
Provider Name (Legal Business Name): SHAWN ANTONIO DWIGHT PMHNP B-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2025
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 WASHINGTON AVE FL 5
TOWSON MD
21204-4763
US

IV. Provider business mailing address

200 WASHINGTON AVE FL 5
TOWSON MD
21204-4763
US

V. Phone/Fax

Practice location:
  • Phone: 443-452-8469
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR257449
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: