Individual provider Active NPI

Victoria Sefcsik-Revelle, DO

  • Family Medicine Physician
  • Shaw AFB, SC
National Provider Identifier
1639879836
Registry record updated Jul 7, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
2024035186 Issued in MO
Practice address
420 Polifka Dr
Shaw AFB, SC 29152-5100
Phone
(803) 985-6587
Fax
(803) 895-6063
NPI assigned
Mar 6, 2023
Last updated
Jul 7, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 7, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 2024035186 MO Primary

Addresses

Primary practice location

420 Polifka Dr
Shaw AFB, SC 29152-5100

Mailing address

420 Polifka Dr
Shaw AFB, SC 29152-5100
Phone (702) 653-2273

Other names 1

  • Victoria Sefcsik Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
2024035186MOMDGeneral Practice Physician
SL2104NVMDStudent in an Organized Health Care Education/Training Program

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1678060800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783382400000",
    "number": "1639879836",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "420 POLIFKA DR",
            "city": "SHAW AFB",
            "state": "SC",
            "postal_code": "291525100",
            "telephone_number": "702-653-2273"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "420 POLIFKA DR",
            "city": "SHAW AFB",
            "state": "SC",
            "postal_code": "291525100",
            "telephone_number": "803-985-6587",
            "fax_number": "803-895-6063"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SEFCSIK-REVELLE",
        "first_name": "VICTORIA",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-03-06",
        "last_updated": "2026-07-07",
        "certification_date": "2026-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "2024035186",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "VICTORIA",
            "last_name": "SEFCSIK",
            "credential": "DO",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Shaw AFB, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.