Provider Demographics
NPI:1154446680
Name:POWELL, SHANTA PEARL HENDERSON (MD)
Entity Type:Individual
Prefix:DR
First Name:SHANTA
Middle Name:PEARL HENDERSON
Last Name:POWELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SHANTA
Other - Middle Name:PEARL
Other - Last Name:HENDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:55 WADE AVE
Mailing Address - Street 2:DAYHOFF B
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-4663
Mailing Address - Country:US
Mailing Address - Phone:410-402-7749
Mailing Address - Fax:410-402-7678
Practice Address - Street 1:55 WADE AVE
Practice Address - Street 2:DAYHOFF B
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-4663
Practice Address - Country:US
Practice Address - Phone:410-402-7749
Practice Address - Fax:410-402-7678
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD633672084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry