MEDICARE: DR. KEGAN SHERARD JESSAMY 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	207RG0100X	Gastroenterology Physician	161954	FL

General Provider Information

NPI Number	:	1770997991
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEGAN SHERARD JESSAMY MD

Provider Business Mailing Address
First Line	:	PO BOX 1345
Second Line	:
City	:	MOUNT DORA
State	:	FL
Zip	:	32756-1345
Country	:	US
Telephone Number	:	352-742-4444
Fax Number	:	352-742-4446

Provider Business Practice Location Address
First Line	:	1858 MAYO DR
Second Line	:
City	:	TAVARES
State	:	FL
Zip	:	32778-4320
Country	:	US
Telephone Number	:	352-383-5200
Fax Number	:	352-383-3534

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

Provider Enumeration Date	:	06/16/2014
Last Update Date	:	05/04/2026

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