Provider Demographics
NPI:1497293286
Name:ROBERTS, SHEQUILA
Entity Type:Individual
Prefix:
First Name:SHEQUILA
Middle Name:
Last Name:ROBERTS
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 1:913 S KIRKMAN RD
Mailing Address - Street 2:259
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32811-2684
Mailing Address - Country:US
Mailing Address - Phone:407-334-7899
Mailing Address - Fax:
Practice Address - Street 1:913 S KIRKMAN RD
Practice Address - Street 2:259
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32811-2684
Practice Address - Country:US
Practice Address - Phone:407-334-7899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-01
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No172V00000XOther Service ProvidersCommunity Health Worker