Healthcare Provider Details

I. General information

NPI: 1669474805
Provider Name (Legal Business Name): KAY MARIE SHAWCHUCK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAY MARIE ABDULLAH M.D.

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 02/11/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6450 38TH AVE N STE 440
ST PETERSBURG FL
33710-1653
US

IV. Provider business mailing address

PO BOX 25317
TAMPA FL
33622-5317
US

V. Phone/Fax

Practice location:
  • Phone: 727-551-2033
  • Fax: 278-641-4477
Mailing address:
  • Phone: 813-286-0033
  • Fax: 813-282-1806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number40854
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number6639
License Number StateND
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME119762
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: