Provider Demographics
NPI:1629091913
Name:STEPHENS, SHAWN MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:MICHAEL
Last Name:STEPHENS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 UNIVERSITY PKWY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34243-2893
Mailing Address - Country:US
Mailing Address - Phone:941-359-8300
Mailing Address - Fax:941-359-8310
Practice Address - Street 1:2401 UNIVERSITY PKWY
Practice Address - Street 2:SUITE 201
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34243-2893
Practice Address - Country:US
Practice Address - Phone:941-359-8300
Practice Address - Fax:941-359-8310
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY240496207V00000X
FLME109905207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL006122400Medicaid
NY02806504Medicaid
NY02806504Medicaid
NYRB45555Medicare PIN