Provider Demographics
NPI:1609162932
Name:ANDERSON, SHEENA S (DO)
Entity Type:Individual
Prefix:DR
First Name:SHEENA
Middle Name:S
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:PO BOX 44004
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32231-4004
Mailing Address - Country:US
Mailing Address - Phone:904-202-1032
Mailing Address - Fax:904-696-1926
Practice Address - Street 1:524 SKYMARKS DR
Practice Address - Street 2:SUITE 1
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-7254
Practice Address - Country:US
Practice Address - Phone:904-696-7333
Practice Address - Fax:904-696-1926
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-24
Last Update Date:2015-11-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLOS13595207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK1951AMedicare PIN