Healthcare Provider Details

I. General information

NPI: 1053528299
Provider Name (Legal Business Name): SHELLY MARIE SEWARD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 05/21/2020
Certification Date: 05/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3438 LAWTON RD # 2D
ORLANDO FL
32803-2948
US

IV. Provider business mailing address

3438 LAWTON RD # 2D
ORLANDO FL
32803-2948
US

V. Phone/Fax

Practice location:
  • Phone: 407-751-2868
  • Fax: 407-904-0410
Mailing address:
  • Phone: 407-751-2868
  • Fax: 407-904-0410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberME135965
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number4301092907
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License NumberME135965
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: