Provider Demographics
NPI:1932295896
Name:DREVON, SHEILAH M (MD)
Entity Type:Individual
Prefix:
First Name:SHEILAH
Middle Name:M
Last Name:DREVON
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:PO BOX 1428
Mailing Address - Street 2:
Mailing Address - City:ELFERS
Mailing Address - State:FL
Mailing Address - Zip Code:34680-1428
Mailing Address - Country:US
Mailing Address - Phone:727-375-2025
Mailing Address - Fax:727-376-4521
Practice Address - Street 1:3527 LITTLE RD
Practice Address - Street 2:
Practice Address - City:TRINITY
Practice Address - State:FL
Practice Address - Zip Code:34655-1811
Practice Address - Country:US
Practice Address - Phone:727-375-2025
Practice Address - Fax:727-376-4521
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0065512207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK5615Medicare ID - Type UnspecifiedGROUP NUMBER
FLF65388Medicare UPIN
FL26190XMedicare ID - Type UnspecifiedINDIVIDUAL NUMBER