Provider Demographics
NPI:1013731959
Name:FUNDORA, SHEYLA (DNP, FNP, BSN, RN)
Entity type:Individual
Prefix:
First Name:SHEYLA
Middle Name:
Last Name:FUNDORA
Suffix:
Gender:F
Credentials:DNP, FNP, BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:585 TILLMAN ST UNIT 1
Mailing Address - Street 2:
Mailing Address - City:HILLSIDE
Mailing Address - State:NJ
Mailing Address - Zip Code:07205-1718
Mailing Address - Country:US
Mailing Address - Phone:786-409-9366
Mailing Address - Fax:
Practice Address - Street 1:585 TILLMAN ST UNIT 1
Practice Address - Street 2:
Practice Address - City:HILLSIDE
Practice Address - State:NJ
Practice Address - Zip Code:07205-1718
Practice Address - Country:US
Practice Address - Phone:786-409-9366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-07
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF354573363LF0000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily