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NPI Code Detail

MEDICARE: DR. SHEA ANN HUMPHREY DO

MEDICARE: DR. SHEA ANN HUMPHREY DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianOS9643FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1174543565
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SHEA ANN HUMPHREY DO
Provider Business Mailing Address
First Line : 110 S WOODLAND ST
Second Line :
City : WINTER GARDEN
State : FL
Zip : 34787-3546
Country : US
Telephone Number : 407-905-8827
Fax Number : 407-905-8980
Provider Business Practice Location Address
First Line : 1296 W BROAD ST
Second Line :
City : GROVELAND
State : FL
Zip : 34736-2012
Country : US
Telephone Number : 352-429-4104
Fax Number : 352-429-4138
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/20/2006
Last Update Date : 12/16/2009

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Directions to “ DR. SHEA ANN HUMPHREY DO” Practice Location

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