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General NPI Number Information
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NPI Number | 1376803577
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Entity Type | Individual
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Provider Name | SHANNON DEAN M.D., PH.D.
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Gender | Female
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Dates
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Enumeration Date | 05/22/2012
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Last Update Date | 09/26/2024
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Provider Practice Location Address
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Address Line | 601 N CAROLINE ST FL 5
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City | BALTIMORE
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State | MD
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Zip | 21287-0006
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Country | US
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Telephone | 410-955-4259
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Fax |
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Provider Business Mailing Address
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Address Line | 6201 GREENLEIGH AVE FL 2
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City | MIDDLE RIVER
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State | MD
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Zip | 21220-2004
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Country | US
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Telephone | 410-933-2719
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Fax | 585-424-7289
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | P27654
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 2084N0600X
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Taxonomy Name | Clinical Neurophysiology Physician
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License Number | 289101
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 2084N0402X
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Taxonomy Name | Neurology with Special Qualifications in Child Neurology Physician
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License Number | P27654
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License Number State | MD
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