Provider Demographics
NPI:1114085669
Name:FITZGERALD, MARYSHEILA ANN (MA AUDC FAAA FADA)
Entity Type:Individual
Prefix:MS
First Name:MARYSHEILA
Middle Name:ANN
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:MA AUDC FAAA FADA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2320 S 22ND DR
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-8867
Mailing Address - Country:US
Mailing Address - Phone:928-783-4476
Mailing Address - Fax:
Practice Address - Street 1:2320 S 22ND DR
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-8867
Practice Address - Country:US
Practice Address - Phone:928-783-4476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2015-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZDA542231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ50113101Medicaid
S38839Medicare UPIN
AZ50113101Medicaid