Provider Demographics
NPI:1588907042
Name:SCHEFANO, DEVON (IDC)
Entity type:Individual
Prefix:
First Name:DEVON
Middle Name:
Last Name:SCHEFANO
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4878 SUSANNA WOODS CT
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257-5264
Mailing Address - Country:US
Mailing Address - Phone:509-270-7502
Mailing Address - Fax:
Practice Address - Street 1:1204 MASSEY AVE
Practice Address - Street 2:
Practice Address - City:MAYPORT
Practice Address - State:FL
Practice Address - Zip Code:32228
Practice Address - Country:US
Practice Address - Phone:904-270-4309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-03
Last Update Date:2015-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman