Individual
KAY MARIE SHAWCHUCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
6450 38TH AVE N STE 440, ST PETERSBURG, FL 33710-1653
(727) 551-2033
(278) 641-4477
Mailing address
PO BOX 25317, TAMPA, FL 33622-5317
(813) 286-0033
(813) 282-1806
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
40854
MN
208600000X
Surgery Physician
6639
ND
208600000X
Surgery Physician
Primary
ME119762
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
013635800
—
FL
01
—
03T04AB
BLUE SHIELD
MN
05
—
17670
—
ND
05
—
67431880
—
MN
01
—
ABD19054
BLUE SHIELD
ND
Enumeration date
06/01/2005
Last updated
02/11/2022
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