Provider Demographics
NPI:1154541621
Name:SEWELL, ELIZABETH SHANNON (MED)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:SHANNON
Last Name:SEWELL
Suffix:
Gender:F
Credentials:MED
Other - Prefix:MRS
Other - First Name:ELIZABETH
Other - Middle Name:SHANNON
Other - Last Name:ROSE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2860 HIGHWAY 71 STE A
Mailing Address - Street 2:
Mailing Address - City:MARIANNA
Mailing Address - State:FL
Mailing Address - Zip Code:32446-1893
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2860 HIGHWAY 71 STE A
Practice Address - Street 2:
Practice Address - City:MARIANNA
Practice Address - State:FL
Practice Address - Zip Code:32446-1893
Practice Address - Country:US
Practice Address - Phone:850-323-1002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No171M00000XOther Service ProvidersCase Manager/Care Coordinator