MEDICARE: MAGNOLIA BAY PEDIATRICS LLC

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	208000000X	Pediatrics Physician

General Provider Information

NPI Number	:	1598699910
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAGNOLIA BAY PEDIATRICS LLC

Provider Business Mailing Address
First Line	:	4304 WINDMILL POINTE DR
Second Line	:
City	:	PLANT CITY
State	:	FL
Zip	:	33567-3645
Country	:	US
Telephone Number	:	813-601-3982
Fax Number	:

Provider Business Practice Location Address
First Line	:	4304 WINDMILL POINTE DR
Second Line	:
City	:	PLANT CITY
State	:	FL
Zip	:	33567-3645
Country	:	US
Telephone Number	:	813-601-3982
Fax Number	:

Authorized Official
Title or Position	:	APRN
Name	:	CHRISTIAN SHEFFIELD
Credential	:	APRN
Telephone Number	:	813-601-3982

Provider Enumeration Date	:	06/10/2026
Last Update Date	:	06/10/2026

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