Provider Demographics
NPI:1518108281
Name:HEBERT-MAGEE, SHANTEL (MD)
Entity Type:Individual
Prefix:
First Name:SHANTEL
Middle Name:
Last Name:HEBERT-MAGEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 E ROLLINS ST
Mailing Address - Street 2:DEPT OF PATHOLOGY
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-1248
Mailing Address - Country:US
Mailing Address - Phone:407-303-7683
Mailing Address - Fax:205-297-9411
Practice Address - Street 1:601 E ROLLINS ST
Practice Address - Street 2:DEPT OF PATHOLOGY
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-1248
Practice Address - Country:US
Practice Address - Phone:407-303-7683
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-10
Last Update Date:2017-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLME116368207ZP0102X
AL29610207ZP0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051117063OtherBCBS
AL128941Medicaid
AL128946Medicaid
AL051117064OtherBCBS
AL051117065OtherBCBS
AL128944Medicaid
MS09207858Medicaid
AL051117065OtherBCBS