Doctor Name: | SHEVONNE ECHETABU |
NPI Number: | 1114273695 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | |
Business Practice Address: | 716 Maiden Choice Ln Suite 305 Catonsville, MD - 212285943 |
Business Phone Number: | 4107479422 |
Business Fax Number: | |
Mailing Address: | 716 Maiden Choice Ln, Suite 305 CATONSVILLE |
State: | MD |
Postal Code: | 212285943 |
Phone Number: | 4107479422 |
Fax Number: | |
NPI Enumeration Date: | 08/02/2012 |
NPI Last Update Date: | 01/14/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |