Provider Demographics
NPI:1790323129
Name:SHEATS, ILANA
Entity Type:Individual
Prefix:
First Name:ILANA
Middle Name:
Last Name:SHEATS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7119 SOMERSET CT
Mailing Address - Street 2:
Mailing Address - City:APTOS
Mailing Address - State:CA
Mailing Address - Zip Code:95003-3663
Mailing Address - Country:US
Mailing Address - Phone:831-219-8608
Mailing Address - Fax:
Practice Address - Street 1:700 FREDERICK ST STE 103
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95062-2239
Practice Address - Country:US
Practice Address - Phone:831-996-1222
Practice Address - Fax:831-417-0443
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-16
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist