Provider Demographics
NPI:1679646954
Name:SHEGOG, MYCHELLE LORRAYNE (MD)
Entity Type:Individual
Prefix:DR
First Name:MYCHELLE
Middle Name:LORRAYNE
Last Name:SHEGOG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 E JEFFERSON ST
Mailing Address - Street 2:KAISER PERMANENTE MEDICARE ENROLLMENT
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4908
Mailing Address - Country:US
Mailing Address - Phone:301-816-2424
Mailing Address - Fax:
Practice Address - Street 1:700 2ND ST NE FL 6
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-8108
Practice Address - Country:US
Practice Address - Phone:202-346-3375
Practice Address - Fax:202-346-3376
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC3016185500207X00000X
CAA75667207X00000X
MDD63615207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
018036K92Medicare ID - Type Unspecified
I43282Medicare UPIN