Individual
SHANNA DANIELLE RAPHAEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
5601 LOCH RAVEN BLVD, BALTIMORE, MD 21239-2945
(443) 834-4351
Mailing address
2079 MISTY MEADOW RD, FINKSBURG, MD 21048-1742
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/02/2019
Last updated
09/28/2020
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