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General NPI Number Information
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NPI Number | 1245128776
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Entity Type | Individual
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Provider Name | SHYJI P MATHEW ARNP
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Gender | Female
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Dates
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Enumeration Date | 06/24/2025
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Last Update Date | 06/26/2025
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Provider Practice Location Address
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Address Line | 311 W OAK ST
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City | KISSIMMEE
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State | FL
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Zip | 34741-4421
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Country | US
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Telephone | 407-933-1423
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Fax |
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Provider Business Mailing Address
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Address Line | 12728 SAWGRASS PLANTATION BLVD
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City | ORLANDO
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State | FL
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Zip | 32824-4833
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Country | US
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Telephone | 407-743-9124
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 364SF0001X
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Taxonomy Name | Family Health Clinical Nurse Specialist
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License Number | 11039574
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License Number State | FL
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