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1992717938

NPI Code Detail

MEDICARE: TRACY SHEVELL MD

MEDICARE: TRACY SHEVELL MD

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	207VG0400X	Gynecology Physician	042137	CT
2	207VG0400X	Gynecology Physician	211664	NY
3	207VM0101X	Maternal & Fetal Medicine Physician	042137	CT
4	207VX0000X	Obstetrics Physician	042137	CT
5	207VX0000X	Obstetrics Physician	211664	NY
6	207VM0101X	Maternal & Fetal Medicine Physician	211664	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	TIN	OTHER	CT	MULTIPLAN
2	729E01	OTHER	CT	EMPIRE BC/BS
3	TIN	OTHER	CT	NEHCA
4	3536566	OTHER	CT	AETNA
5	TIN	OTHER	CT	NORTHEAST HEALTH DIRECT
6	TIN	OTHER	CT	MANAGED CARE STRATGIES
7	2V4608	OTHER	CT	HEALTH NET
8	P3232398	OTHER	CT	OXFORD HEALTH PLAN
9	TIN	OTHER	CT	POMCO
10	TIN	OTHER	CT	PRIVATE HEALTHCARE SYSTEM
11	TIN	OTHER	CT	CONSUMER HELATH NETWORK
12	010042137CT01	OTHER	CT	ANTHEM BC/BS
13	4605229	OTHER	CT	CIGNA
14	TIN	OTHER	CT	FOCUS-CONENTRA
15	855116	OTHER	CT	CONNECTICARE
16	TIN	OTHER	CT	UNITED HEALTH CARE
17	TIN	OTHER	CT	HEALTHCARE VALUE MGMT

General Provider Information

NPI Number	:	1992717938
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACY SHEVELL MD

Provider Business Mailing Address
First Line	:	MATERNAL FETAL MEDICINE OBGYN/NORTHWELL HEALTH
Second Line	:	480 BEDFORD RD
City	:	CHAPPAQUA
State	:	NY
Zip	:	10514
Country	:	US
Telephone Number	:	914-458-8800
Fax Number	:

Provider Business Practice Location Address
First Line	:	480 BEDFORD RD
Second Line	:
City	:	CHAPPAQUA
State	:	NY
Zip	:	10514-1715
Country	:	US
Telephone Number	:	203-276-7060
Fax Number	:

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

Provider Enumeration Date	:	08/11/2006
Last Update Date	:	05/11/2021

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Directions to “ TRACY SHEVELL MD” Practice Location

Language	Start Address	Practice Location

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