Provider Demographics
NPI:1518506260
Name:DUPUY, SHEILA GHAZAL (PA-C)
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:GHAZAL
Last Name:DUPUY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1024 N BLACK CHERRY DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32259-4098
Mailing Address - Country:US
Mailing Address - Phone:904-322-2188
Mailing Address - Fax:
Practice Address - Street 1:1024 N BLACK CHERRY DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32259-4098
Practice Address - Country:US
Practice Address - Phone:904-322-2188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-29
Last Update Date:2019-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9112228363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant