Provider Demographics
NPI:1659307759
Name:JOSE, SHEENA MARY (MD)
Entity Type:Individual
Prefix:DR
First Name:SHEENA
Middle Name:MARY
Last Name:JOSE
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Gender:F
Credentials:MD
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Mailing Address - Street 1:10967 LAKE UNDER HILL RD
Mailing Address - Street 2:UNIT 137
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825-4455
Mailing Address - Country:US
Mailing Address - Phone:407-930-1030
Mailing Address - Fax:407-386-7277
Practice Address - Street 1:10967 LAKE UNDER HILL RD
Practice Address - Street 2:UNIT 137
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32825-4455
Practice Address - Country:US
Practice Address - Phone:407-930-1030
Practice Address - Fax:407-386-7277
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2019-08-12
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Provider Licenses
StateLicense IDTaxonomies
FLME109765207RI0200X, 207RG0300X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004574400Medicaid