Provider Demographics
NPI:1174212856
Name:FONTANILLAS-DURAN, SHEILA
Entity type:Individual
Prefix:
First Name:SHEILA
Middle Name:
Last Name:FONTANILLAS-DURAN
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 1:415 S CHICKASAW TRL
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825-7803
Mailing Address - Country:US
Mailing Address - Phone:407-264-7407
Mailing Address - Fax:
Practice Address - Street 1:415 S CHICKASAW TRL
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32825-7803
Practice Address - Country:US
Practice Address - Phone:407-264-7407
Practice Address - Fax:407-382-2489
Is Sole Proprietor?:No
Enumeration Date:2023-05-08
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAST1216237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist