Individual
SHAVONTAY TATE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
5601 LOCH RAVEN BLVD, BALTIMORE, MD 21239-2945
(443) 469-8227
Mailing address
201 E UNIVERSITY PKWY, BALTIMORE, MD 21218-2829
(410) 554-2000
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
MD
Other
Enumeration date
12/05/2021
Last updated
03/16/2022
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