Healthcare Provider Details

I. General information

NPI: 1548097272
Provider Name (Legal Business Name): SHAEVOUN OGARRO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2024
Last Update Date: 09/17/2024
Certification Date: 09/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N DEAN RD
ORLANDO FL
32825-3710
US

IV. Provider business mailing address

1243 PARKLAND CT
ALTAMONTE SPRINGS FL
32714-1258
US

V. Phone/Fax

Practice location:
  • Phone: 407-384-7388
  • Fax:
Mailing address:
  • Phone: 504-237-2090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number11030158
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: