Provider Demographics
NPI:1538470877
Name:ST. MARIE, SHAWN PATRICK (DO)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:PATRICK
Last Name:ST. MARIE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4625 HALDER LN STE C
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32814-6416
Mailing Address - Country:US
Mailing Address - Phone:407-506-4776
Mailing Address - Fax:407-203-4018
Practice Address - Street 1:4625 HALDER LN STE C
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32814-6416
Practice Address - Country:US
Practice Address - Phone:407-506-4776
Practice Address - Fax:407-203-4018
Is Sole Proprietor?:No
Enumeration Date:2010-07-01
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0S12737208M00000X
FLUO2277204D00000X, 207R00000X
MAMA244984207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine