Provider Demographics
NPI:1427367069
Name:HOWELL, SHAUNDA LANE SMITH (PA-C)
Entity Type:Individual
Prefix:
First Name:SHAUNDA
Middle Name:LANE SMITH
Last Name:HOWELL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SHAUNDA
Other - Middle Name:LANE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:P.O. BOX 845347
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-5347
Mailing Address - Country:US
Mailing Address - Phone:214-645-7700
Mailing Address - Fax:214-645-7701
Practice Address - Street 1:5323 HARRY HINES BOULEVARD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-7208
Practice Address - Country:US
Practice Address - Phone:214-645-7700
Practice Address - Fax:214-645-7701
Is Sole Proprietor?:No
Enumeration Date:2010-09-30
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZPAT9105640363A00000X
TXPA09870363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant