1861825739 NPI number — SHELAGH KATHRYN WOOD-GOUVEIA NP

Table of content: SHELAGH KATHRYN WOOD-GOUVEIA NP (NPI 1861825739)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861825739 NPI number — SHELAGH KATHRYN WOOD-GOUVEIA NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WOOD-GOUVEIA
Provider First Name:
SHELAGH
Provider Middle Name:
KATHRYN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1861825739
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/19/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
ORLANDO VA MEDICAL CENTER
Provider Second Line Business Mailing Address:
13800 VETERANS WAY
Provider Business Mailing Address City Name:
ORLANDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32827
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-631-1000
Provider Business Mailing Address Fax Number:
401-453-3049

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1390 EAST BURLEIGH BLVD.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TAVARES
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32778
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-253-2900
Provider Business Practice Location Address Fax Number:
407-513-9232
Provider Enumeration Date:
08/15/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LA2200X , with the licence number:  206090 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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