MEDICARE: DR. SHEENA MARY JOSE MD

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	207RI0200X	Infectious Disease Physician	ME109765	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	:	1659307759
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHEENA MARY JOSE MD

Provider Business Mailing Address
First Line	:	10967 LAKE UNDER HILL RD
Second Line	:	UNIT 137
City	:	ORLANDO
State	:	FL
Zip	:	32825-4455
Country	:	US
Telephone Number	:	407-930-1030
Fax Number	:	407-386-7277

Provider Business Practice Location Address
First Line	:	10967 LAKE UNDER HILL RD
Second Line	:	UNIT 137
City	:	ORLANDO
State	:	FL
Zip	:	32825-4455
Country	:	US
Telephone Number	:	407-930-1030
Fax Number	:	407-386-7277

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

Provider Enumeration Date	:	06/23/2006
Last Update Date	:	08/12/2019

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