Provider Demographics
NPI:1942507884
Name:SHEDD, JOHN GRAVES IV (MD)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:GRAVES
Last Name:SHEDD
Suffix:IV
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4800 N. FEDERAL HWY
Mailing Address - Street 2:SUITE B103
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-5177
Mailing Address - Country:US
Mailing Address - Phone:561-886-0970
Mailing Address - Fax:561-886-0980
Practice Address - Street 1:4800 N. FEDERAL HWY
Practice Address - Street 2:SUITE B103
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-5177
Practice Address - Country:US
Practice Address - Phone:561-886-0970
Practice Address - Fax:561-886-0980
Is Sole Proprietor?:No
Enumeration Date:2011-02-11
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME38636207Q00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL069496700Medicaid