Provider Demographics
NPI:1457080731
Name:GOREY, DEVINN SHAVONNE
Entity Type:Individual
Prefix:
First Name:DEVINN
Middle Name:SHAVONNE
Last Name:GOREY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 S ORANGE AVE STE 500
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-2967
Mailing Address - Country:US
Mailing Address - Phone:407-540-1000
Mailing Address - Fax:407-540-1011
Practice Address - Street 1:1720 S ORANGE AVE STE 500
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-2967
Practice Address - Country:US
Practice Address - Phone:407-540-1000
Practice Address - Fax:407-540-1011
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-10
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLPA9116380363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program