Provider Demographics
NPI:1629251020
Name:LILLIS, SHEENA LYNN
Entity Type:Individual
Prefix:
First Name:SHEENA
Middle Name:LYNN
Last Name:LILLIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHEENA
Other - Middle Name:LYNN
Other - Last Name:PANONCILLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:222 HUGH THOMAS DR
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32404-8538
Mailing Address - Country:US
Mailing Address - Phone:850-814-7880
Mailing Address - Fax:
Practice Address - Street 1:246 MAIN STREET
Practice Address - Street 2:STE 8
Practice Address - City:NEW PALTZ
Practice Address - State:NY
Practice Address - Zip Code:12561-1621
Practice Address - Country:US
Practice Address - Phone:845-419-5033
Practice Address - Fax:845-419-5106
Is Sole Proprietor?:No
Enumeration Date:2007-12-10
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL209352251S0007X
NY028819225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports