Provider Demographics
NPI:1205139383
Name:VARGHESE, SHEENA MATHAI (PA)
Entity type:Individual
Prefix:
First Name:SHEENA
Middle Name:MATHAI
Last Name:VARGHESE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:SHEENA
Other - Middle Name:
Other - Last Name:MATHAI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:1243 ALEX DR
Mailing Address - Street 2:
Mailing Address - City:NORTH BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08902-5705
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14223 GULF BLVD
Practice Address - Street 2:
Practice Address - City:MADEIRA BEACH
Practice Address - State:FL
Practice Address - Zip Code:33708-2236
Practice Address - Country:US
Practice Address - Phone:727-510-6296
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-13
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA 9105694208800000X
FLPA9105694363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No208800000XAllopathic & Osteopathic PhysiciansUrology