MEDICARE: DR. MARY ELLEN SHRIVER D.O.

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
1	2084N0400X	Neurology Physician	OS0006163	FL

Other Identifiers

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

General Provider Information

NPI Number	:	1316999519
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY ELLEN SHRIVER D.O.

Provider Business Mailing Address
First Line	:	6101 WEBB RD
Second Line	:	SUITE 210
City	:	TAMPA
State	:	FL
Zip	:	33615-2872
Country	:	US
Telephone Number	:	813-249-0922
Fax Number	:	813-886-3903

Provider Business Practice Location Address
First Line	:	6101 WEBB RD
Second Line	:	SUITE 210
City	:	TAMPA
State	:	FL
Zip	:	33615-2872
Country	:	US
Telephone Number	:	813-249-0922
Fax Number	:	813-886-3903

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/16/2006
Last Update Date	:	07/08/2007

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