Healthcare Provider Details

I. General information

NPI: 1679438881
Provider Name (Legal Business Name): SHEBA MARY CHERIAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3003 W DR MARTIN LUTHER KING JR BLVD
TAMPA FL
33607-6307
US

IV. Provider business mailing address

3503 E FRONTAGE RD
TAMPA FL
33607-1742
US

V. Phone/Fax

Practice location:
  • Phone: 813-554-8983
  • Fax: 813-443-8177
Mailing address:
  • Phone: 813-586-8187
  • Fax: 813-605-6228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License NumberPA9120293
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: