Healthcare Provider Details

I. General information

NPI: 1487744892
Provider Name (Legal Business Name): SHEYNA NOEL CARROCCIO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2006
Last Update Date: 01/09/2025
Certification Date: 07/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6440 W NEWBERRY RD SUITE 111
GAINESVILLE FL
32605
US

IV. Provider business mailing address

6440 W NEWBERRY RD SUITE 111
GAINESVILLE FL
32605
US

V. Phone/Fax

Practice location:
  • Phone: 352-331-3332
  • Fax: 352-331-3320
Mailing address:
  • Phone: 352-331-3332
  • Fax: 352-331-3320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberME99929
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberME99929
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: