Individual
SHOSHANA MAXWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
12360 E BURNSIDE ST, PORTLAND, OR 97233-1042
(971) 279-4800
(971) 279-2051
Mailing address
211 SE CARUTHERS ST, PORTLAND, OR 97214-4502
(503) 224-1044
(971) 260-0355
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
DO193262
OR
207Q00000X
Family Medicine Physician
OP60946753
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2061406
—
WA
05
—
500767655
—
OR
Enumeration date
05/26/2016
Last updated
07/29/2025
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