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General NPI Number Information
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NPI Number | 1528221603
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Entity Type | Individual
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Provider Name | SHANNON M POWELL MD
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Gender | Female
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Dates
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Enumeration Date | 07/08/2008
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Last Update Date | 05/06/2019
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Provider Practice Location Address
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Address Line | 3535 SOUTHERN BLVD
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City | DAYTON
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State | OH
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Zip | 45429-1221
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Country | US
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Telephone | 937-395-8627
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Fax |
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Provider Business Mailing Address
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Address Line | L-3402
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City | COLUMBUS
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State | OH
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Zip | 43260-0001
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Country | US
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Telephone | 814-444-1919
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Fax |
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 35.099753
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 0101243906
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License Number State | VA
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