Provider Demographics
NPI:1669213039
Name:DE JESUS, SHEILA
Entity type:Individual
Prefix:
First Name:SHEILA
Middle Name:
Last Name:DE JESUS
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:F5 URB FLAMBOYANES
Mailing Address - Street 2:
Mailing Address - City:SANTA ISABEL
Mailing Address - State:PR
Mailing Address - Zip Code:00757-1829
Mailing Address - Country:US
Mailing Address - Phone:787-645-7400
Mailing Address - Fax:787-845-0044
Practice Address - Street 1:F5 URB FLAMBOYANES
Practice Address - Street 2:
Practice Address - City:SANTA ISABEL
Practice Address - State:PR
Practice Address - Zip Code:00757-1829
Practice Address - Country:US
Practice Address - Phone:787-645-7400
Practice Address - Fax:787-845-0044
Is Sole Proprietor?:No
Enumeration Date:2024-06-01
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR665156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician