Provider Demographics
NPI:1457445603
Name:LEE, SHEILA J (ARNP)
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:J
Last Name:LEE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2575 N COURTENAY PKWY
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32953
Mailing Address - Country:US
Mailing Address - Phone:321-454-7148
Mailing Address - Fax:321-449-5015
Practice Address - Street 1:611 SINGLETON AVE
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32796
Practice Address - Country:US
Practice Address - Phone:321-269-6389
Practice Address - Fax:321-383-5127
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLARNP1084712367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL305755100Medicaid