Individual
PHILIP SHENEFELT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
12901 BRUCE B DOWNS BLVD, MDC 79, TAMPA, FL 33612-4742
(813) 974-2920
Mailing address
PO BOX 917770, ORLANDO, FL 32891-7770
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
ME50881
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
04534
BLUE CROSS BLUE SHIELD
FL
05
—
046764200
—
FL
Enumeration date
06/03/2006
Last updated
02/18/2019
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