Provider Demographics
NPI:1316999519
Name:SHRIVER, MARY ELLEN (DO)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:ELLEN
Last Name:SHRIVER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:6101 WEBB RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-2872
Mailing Address - Country:US
Mailing Address - Phone:813-249-0922
Mailing Address - Fax:813-886-3903
Practice Address - Street 1:6101 WEBB RD
Practice Address - Street 2:SUITE 210
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-2872
Practice Address - Country:US
Practice Address - Phone:813-249-0922
Practice Address - Fax:813-886-3903
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOS00061632084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL376748500Medicaid
FLF78252Medicare UPIN
FL80882XMedicare ID - Type Unspecified