Shantell S Wray, PA is a
Physician Assistant based in Groveland, Florida. Shantell S Wray is licensed to practice in Connecticut (license number 002435) and her current practice location is
1296 W Broad St, Groveland, Florida. She can be reached at her office (for appointments etc.) via phone at
(407) 905-8827.
NPI number for Shantell S Wray is 1609966993 and her current mailing address is 110 S Woodland St, Winter Garden, Florida. She
does not participate in medicare program and thus does not accept medicare assignments. Her NPI Number is 1609966993.
Provider's Profile
| Full Name | Shantell S Wray |
|---|
| Gender | Female |
|---|
| Speciality | Physician Assistant |
|---|
| Location | 1296 W Broad St, Groveland, Florida |
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| Accepts Medicare Assignments | Does not participate in Medicare Program. She may not accept medicare assignment. |
|---|
NPI Data:
- NPI Number: 1609966993
- Provider Enumeration Date: 10/15/2006
- Last Update Date: 10/03/2022
Medical Identifiers
Medical identifiers for Shantell S Wray such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1609966993 | NPI | - | NPPES |
| 1071883 | Other | | NCCPA |
| 115500100 | Medicaid | FL | |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 363A00000X | Physician Assistant | 002435 (Connecticut) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Shantell S Wray is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Shantell S Wray, PA
110 S Woodland St,
Winter Garden, FL 34787-3546
Ph: (407) 905-8827 | Shantell S Wray, PA
1296 W Broad St,
Groveland, FL 34736-2012
Ph: (407) 905-8827 |
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