Provider Demographics
NPI:1245422484
Name:RODRIGUEZ MADERA, SHEILLA LEE (PHD)
Entity Type:Individual
Prefix:DR
First Name:SHEILLA
Middle Name:LEE
Last Name:RODRIGUEZ MADERA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 CONDADO AVE, COND CONDADO
Mailing Address - Street 2:SUITE 401
Mailing Address - City:SANTURCE
Mailing Address - State:PR
Mailing Address - Zip Code:00907
Mailing Address - Country:US
Mailing Address - Phone:787-725-5013
Mailing Address - Fax:787-725-5013
Practice Address - Street 1:CONDADO AVE 607, COND CONDADO
Practice Address - Street 2:SUITE 401
Practice Address - City:SANTURCE
Practice Address - State:PR
Practice Address - Zip Code:00907
Practice Address - Country:US
Practice Address - Phone:787-725-5013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-13
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2144103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical