Provider Demographics
NPI:1134484066
Name:AGUINACO SHELLEDY, MARIA A
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:A
Last Name:AGUINACO SHELLEDY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 S GROVE AVE
Mailing Address - Street 2:UNIT D
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-2881
Mailing Address - Country:US
Mailing Address - Phone:501-831-1158
Mailing Address - Fax:
Practice Address - Street 1:116 S GROVE AVE
Practice Address - Street 2:UNIT D
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-2881
Practice Address - Country:US
Practice Address - Phone:501-831-1158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-06
Last Update Date:2012-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL171R00000X171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter