Provider Demographics
NPI:1053528299
Name:SEWARD, SHELLY MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:SHELLY
Middle Name:MARIE
Last Name:SEWARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3438 LAWTON RD # 2D
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-2948
Mailing Address - Country:US
Mailing Address - Phone:407-751-2868
Mailing Address - Fax:407-904-0410
Practice Address - Street 1:3438 LAWTON RD # 2D
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-2948
Practice Address - Country:US
Practice Address - Phone:407-751-2868
Practice Address - Fax:407-904-0410
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME135965207V00000X, 207VX0201X
MI4301092907207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P30630831Medicare PIN