MEDICARE: KEVYN MARSHALL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	11047882	FL

General Provider Information

NPI Number	:	1205768983
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVYN MARSHALL

Provider Business Mailing Address
First Line	:	5613 NW 117TH AVE
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33076-3617
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10220 W SAMPLE RD
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33065-3940
Country	:	US
Telephone Number	:	954-340-1123
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/29/2026
Last Update Date	:	05/29/2026

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Directions to “ KEVYN MARSHALL ” Practice Location

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