Provider Demographics
NPI:1003442997
Name:SOWELL, SHANNA LESLIE
Entity Type:Individual
Prefix:
First Name:SHANNA
Middle Name:LESLIE
Last Name:SOWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 SOUTH 31ST STREET
Mailing Address - Street 2:MS-01-E316A
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76508
Mailing Address - Country:US
Mailing Address - Phone:254-724-7588
Mailing Address - Fax:
Practice Address - Street 1:2401 SOUTH 31ST STREET
Practice Address - Street 2:MS-01-E316A
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76508
Practice Address - Country:US
Practice Address - Phone:254-724-7588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-23
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program