Provider Demographics
NPI:1568430049
Name:JAIME, SHIRLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:SHIRLEY
Middle Name:
Last Name:JAIME
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB ONEILL
Mailing Address - Street 2:CALLC C K-2
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674
Mailing Address - Country:US
Mailing Address - Phone:787-854-1356
Mailing Address - Fax:787-871-3960
Practice Address - Street 1:ROAD 149 KM 12.3
Practice Address - Street 2:
Practice Address - City:CIALES
Practice Address - State:PR
Practice Address - Zip Code:00638-1427
Practice Address - Country:US
Practice Address - Phone:787-871-0601
Practice Address - Fax:787-871-3960
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-09
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11364208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR84525OtherMEDICAL SERVICE
PRG40448Medicare UPIN