Provider Demographics
NPI:1598152571
Name:MEDINA AVILES, SHARLENE (MD)
Entity Type:Individual
Prefix:DR
First Name:SHARLENE
Middle Name:
Last Name:MEDINA AVILES
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 1:270 CALLE LA CANDELARIA
Mailing Address - Street 2:PO BOX 8095
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-2116
Mailing Address - Country:US
Mailing Address - Phone:787-455-0498
Mailing Address - Fax:
Practice Address - Street 1:EDIFICIO PARRA SUITE 1003
Practice Address - Street 2:2213 PONCE BYPASS
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717
Practice Address - Country:US
Practice Address - Phone:787-455-0498
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-17
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR19657207R00000X, 207RI0011X
PR32609390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology