MEDICARE: DEVINN SHAVONNE GOREY

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	390200000X	Student in an Organized Health Care Education/Training Program
2	363AS0400X	Surgical Physician Assistant	PA9116380	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457080731
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEVINN SHAVONNE GOREY

Provider Business Mailing Address
First Line	:	1720 S ORANGE AVE STE 500
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32806-2967
Country	:	US
Telephone Number	:	407-540-1000
Fax Number	:	407-540-1011

Provider Business Practice Location Address
First Line	:	1720 S ORANGE AVE STE 500
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32806-2967
Country	:	US
Telephone Number	:	407-540-1000
Fax Number	:	407-540-1011

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

Provider Enumeration Date	:	06/10/2022
Last Update Date	:	12/20/2022

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Directions to “ DEVINN SHAVONNE GOREY ” Practice Location

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