Provider Demographics
NPI:1083020408
Name:URDAZ, SHEENA L (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:SHEENA
Middle Name:L
Last Name:URDAZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2326 S CONGRESS AVE STE 1A
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33406-7652
Mailing Address - Country:US
Mailing Address - Phone:561-433-5577
Mailing Address - Fax:561-275-2696
Practice Address - Street 1:10151 ENTERPRISE CTR STE 205
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437-3761
Practice Address - Country:US
Practice Address - Phone:561-433-5577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-07
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA7209363A00000X
FL9108922363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant