Provider Demographics
NPI:1659699254
Name:HOWARD, SHEANITA R (MD)
Entity Type:Individual
Prefix:
First Name:SHEANITA
Middle Name:R
Last Name:HOWARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 CARAWAY CT STE 106
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-5462
Mailing Address - Country:US
Mailing Address - Phone:301-322-9500
Mailing Address - Fax:301-322-2227
Practice Address - Street 1:1300 CARAWAY CT STE 106
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774-5462
Practice Address - Country:US
Practice Address - Phone:301-322-9500
Practice Address - Fax:301-322-2227
Is Sole Proprietor?:No
Enumeration Date:2010-05-07
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MDD00762892080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD114350600Medicaid