Provider Demographics
NPI:1548481716
Name:GREGORY, MEDINA H (DO)
Entity type:Individual
Prefix:
First Name:MEDINA
Middle Name:H
Last Name:GREGORY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:MEDINA
Other - Middle Name:H
Other - Last Name:SHALTRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1406 CREEK NINE DR
Mailing Address - Street 2:
Mailing Address - City:NORTH PORT
Mailing Address - State:FL
Mailing Address - Zip Code:34291-8036
Mailing Address - Country:US
Mailing Address - Phone:989-350-8266
Mailing Address - Fax:
Practice Address - Street 1:983 S BENEVA RD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34232-2401
Practice Address - Country:US
Practice Address - Phone:941-365-5355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2025-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101015366207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5179054Medicaid
MI0556910245OtherBLUE SHIELD
MI0M10800005Medicare PIN