Provider Demographics
NPI:1205139383
Name:VARGHESE, SHEENA MATHAI (PA-C)
Entity type:Individual
Prefix:
First Name:SHEENA
Middle Name:MATHAI
Last Name:VARGHESE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SHEENA
Other - Middle Name:
Other - Last Name:MATHAI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:14422 SHORESIDE WAY STE 110189
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-4938
Mailing Address - Country:US
Mailing Address - Phone:407-476-1498
Mailing Address - Fax:
Practice Address - Street 1:3125 BRUTON BLVD STE A
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32805-6608
Practice Address - Country:US
Practice Address - Phone:407-476-1498
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-13
Last Update Date:2025-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9105694363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant