Provider Demographics
NPI:1992717938
Name:SHEVELL, TRACY (MD)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:SHEVELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MATERNAL FETAL MEDICINE OBGYN/NORTHWELL HEALTH
Mailing Address - Street 2:480 BEDFORD RD
Mailing Address - City:CHAPPAQUA
Mailing Address - State:NY
Mailing Address - Zip Code:10514
Mailing Address - Country:US
Mailing Address - Phone:914-458-8800
Mailing Address - Fax:
Practice Address - Street 1:480 BEDFORD RD
Practice Address - Street 2:
Practice Address - City:CHAPPAQUA
Practice Address - State:NY
Practice Address - Zip Code:10514-1715
Practice Address - Country:US
Practice Address - Phone:203-276-7060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT042137207VG0400X, 207VM0101X, 207VX0000X
NY211664207VG0400X, 207VX0000X, 207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTTINOtherMULTIPLAN
CT729E01OtherEMPIRE BC/BS
CTTINOtherNEHCA
CT3536566OtherAETNA
CTTINOtherNORTHEAST HEALTH DIRECT
CTTINOtherMANAGED CARE STRATGIES
CT2V4608OtherHEALTH NET
CTP3232398OtherOXFORD HEALTH PLAN
CTTINOtherPOMCO
CTTINOtherPRIVATE HEALTHCARE SYSTEM
CTTINOtherCONSUMER HELATH NETWORK
CT010042137CT01OtherANTHEM BC/BS
CT4605229OtherCIGNA
CTTINOtherFOCUS-CONENTRA
CT855116OtherCONNECTICARE
CTTINOtherUNITED HEALTH CARE
CTTINOtherHEALTHCARE VALUE MGMT