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NPI Code Detail

MEDICARE: EVERGREEN HEALTHCARE COOPERATION PLLC

MEDICARE: EVERGREEN HEALTHCARE COOPERATION PLLC
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
12085U0001XDiagnostic Ultrasound Physician
2208D00000XGeneral Practice Physician

General Provider Information

NPI Number : 1598636227
Entity Type Code : Organization
Provider Name (Legal Business Name) : EVERGREEN HEALTHCARE COOPERATION PLLC
Provider Business Mailing Address
First Line : 400 N TAMPA ST STE 1550
Second Line :
City : TAMPA
State : FL
Zip : 33602-4737
Country : US
Telephone Number :
Fax Number : 804-415-4040
Provider Business Practice Location Address
First Line : 400 N TAMPA ST STE 1550
Second Line :
City : TAMPA
State : FL
Zip : 33602-4737
Country : US
Telephone Number : 917-428-8463
Fax Number : 804-415-4040
Authorized Official
Title or Position : CEO
Name : MR. VINO SHAN
Credential : MD
Telephone Number : 813-380-4645
Provider Enumeration Date : 09/16/2025
Last Update Date : 06/05/2026

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Directions to “EVERGREEN HEALTHCARE COOPERATION PLLC ” Practice Location

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