Provider Demographics
NPI:1386281087
Name:POWELL, DESHAI (HAB, FST)
Entity type:Individual
Prefix:
First Name:DESHAI
Middle Name:
Last Name:POWELL
Suffix:
Gender:M
Credentials:HAB, FST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9135 N MERIDIAN ST STE B8
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-1816
Mailing Address - Country:US
Mailing Address - Phone:317-750-5189
Mailing Address - Fax:
Practice Address - Street 1:9135 N MERIDIAN ST STE B8
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-1816
Practice Address - Country:US
Practice Address - Phone:317-750-5189
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-02
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
373H00000X
IN000000373H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist