Provider Demographics
NPI:1215040894
Name:GONZALEZ, SHEILA IVETTE (MD)
Entity Type:Individual
Prefix:DR
First Name:SHEILA
Middle Name:IVETTE
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4205 BELFORT RD STE 4015
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-3623
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:904-450-6401
Practice Address - Street 1:1658 ST VINCENTS WAY STE 240
Practice Address - Street 2:
Practice Address - City:MIDDLEBURG
Practice Address - State:FL
Practice Address - Zip Code:32068-8459
Practice Address - Country:US
Practice Address - Phone:904-449-7288
Practice Address - Fax:904-203-2173
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2018-04-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PR13430207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRH93181Medicare UPIN