MEDICARE: MANASOTA OBGYN ASSOCIATES LLC

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	207V00000X	Obstetrics & Gynecology Physician

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	:	1700391414
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MANASOTA OBGYN ASSOCIATES LLC

Provider Business Mailing Address
First Line	:	PO BOX 828
Second Line	:
City	:	TALLEVAST
State	:	FL
Zip	:	34270-0828
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2401 UNIVERSITY PKWY STE 201
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34243-2973
Country	:	US
Telephone Number	:	941-359-8300
Fax Number	:	941-359-8310

Authorized Official
Title or Position	:	OWNER
Name	:	DR. SHAWN STEPHENS
Credential	:	MD
Telephone Number	:	941-359-8300

Provider Enumeration Date	:	12/05/2017
Last Update Date	:	12/20/2017

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