Provider Demographics
NPI:1629256417
Name:AARON M SHEVLIN DPM PA
Entity Type:Organization
Organization Name:AARON M SHEVLIN DPM PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEVLIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:772-335-1200
Mailing Address - Street 1:1696 SE HILLMOOR DR
Mailing Address - Street 2:STE B
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-7699
Mailing Address - Country:US
Mailing Address - Phone:772-335-1200
Mailing Address - Fax:772-335-1292
Practice Address - Street 1:1696 SE HILLMOOR DR
Practice Address - Street 2:STE B
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-7699
Practice Address - Country:US
Practice Address - Phone:772-335-1200
Practice Address - Fax:772-335-1292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-05
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0617790001Medicare NSC