Provider Demographics
NPI:1689320889
Name:SNOW, SHELLI A (MD, ADT)
Entity Type:Individual
Prefix:
First Name:SHELLI
Middle Name:A
Last Name:SNOW
Suffix:
Gender:F
Credentials:MD, ADT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1209 ARGYLE AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21217-2928
Mailing Address - Country:US
Mailing Address - Phone:443-473-6529
Mailing Address - Fax:
Practice Address - Street 1:2601 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21217-1817
Practice Address - Country:US
Practice Address - Phone:443-473-6529
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-25
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD101YA0400X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)