Provider Demographics
NPI:1114247079
Name:AGEE, SHAWN (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:
Last Name:AGEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:7740 POINT MEADOWS DR
Mailing Address - Street 2:SUITE 3A
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-9179
Mailing Address - Country:US
Mailing Address - Phone:904-527-3577
Mailing Address - Fax:904-527-3514
Practice Address - Street 1:7740 POINT MEADOWS DR
Practice Address - Street 2:SUITE 3A
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-9179
Practice Address - Country:US
Practice Address - Phone:904-527-3577
Practice Address - Fax:904-527-3514
Is Sole Proprietor?:No
Enumeration Date:2010-06-02
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME123691207W00000X, 207WX0107X
GA74257207W00000X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003173341AMedicaid
FL016739900Medicaid
FLIF385ZMedicare PIN
FL016739900Medicaid