Provider Demographics
NPI:1578071049
Name:PAGAN NIEVES, SHEILA AMARILYS (PHD)
Entity Type:Individual
Prefix:DR
First Name:SHEILA
Middle Name:AMARILYS
Last Name:PAGAN NIEVES
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:PO BOX 549
Mailing Address - Street 2:
Mailing Address - City:NARANJITO
Mailing Address - State:PR
Mailing Address - Zip Code:00719-0549
Mailing Address - Country:US
Mailing Address - Phone:787-368-3004
Mailing Address - Fax:
Practice Address - Street 1:130 CALLE GEORGETTI
Practice Address - Street 2:
Practice Address - City:NARANJITO
Practice Address - State:PR
Practice Address - Zip Code:00719-3012
Practice Address - Country:US
Practice Address - Phone:787-869-7213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-17
Last Update Date:2018-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5972103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical