MEDICARE: SHARONICA POWELL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1659998821
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHARONICA POWELL

Provider Business Mailing Address
First Line	:	3434 SWISS AVE STE 400
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75204-6251
Country	:	US
Telephone Number	:	469-800-7680
Fax Number	:

Provider Business Practice Location Address
First Line	:	3434 SWISS AVE STE 400
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75204-6251
Country	:	US
Telephone Number	:	469-800-7680
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/02/2020
Last Update Date	:	05/28/2026

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Directions to “ SHARONICA POWELL ” Practice Location

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