Provider Demographics
NPI:1376022533
Name:COLWELL, SHAWN THOMAS (RNFA)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:THOMAS
Last Name:COLWELL
Suffix:
Gender:M
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 DOGWOOD LN
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28409-5805
Mailing Address - Country:US
Mailing Address - Phone:910-409-9427
Mailing Address - Fax:
Practice Address - Street 1:411 DOGWOOD LN
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28409-5805
Practice Address - Country:US
Practice Address - Phone:910-409-9427
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-08
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC253656208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery