Healthcare Provider Details

I. General information

NPI: 1457264632
Provider Name (Legal Business Name): SHEVAUGHN VERNON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

671 WINYAH DR
ORLANDO FL
32803-1226
US

IV. Provider business mailing address

8691 NW 27TH PL
SUNRISE FL
33322-2308
US

V. Phone/Fax

Practice location:
  • Phone: 407-303-7747
  • Fax:
Mailing address:
  • Phone: 954-599-6193
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: