Individual
DR. SHANNON M POWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3535 SOUTHERN BLVD, DAYTON, OH 45429-1221
(937) 395-8627
Mailing address
L-3402, COLUMBUS, OH 43260-0001
(814) 444-1919
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
0101243906
VA
2085R0202X
Diagnostic Radiology Physician
Primary
35.099753
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0101243906
LICENSE
VA
05
—
1528221603
—
VA
Enumeration date
07/08/2008
Last updated
05/06/2019
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