Provider Demographics
NPI:1821544065
Name:SHILLINGFORD, CATHLINE
Entity Type:Individual
Prefix:
First Name:CATHLINE
Middle Name:
Last Name:SHILLINGFORD
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 1:3128 DEL AIR DRIVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32818-2916
Mailing Address - Country:US
Mailing Address - Phone:386-333-1442
Mailing Address - Fax:
Practice Address - Street 1:3128 DEL BON DRIVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32818-2916
Practice Address - Country:US
Practice Address - Phone:386-333-1442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-28
Last Update Date:2016-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI453953760163W00000X, 163WC1500X
172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No172V00000XOther Service ProvidersCommunity Health Worker