Provider Demographics
NPI:1790813897
Name:DIAZ, SHEILA G
Entity type:Individual
Prefix:
First Name:SHEILA
Middle Name:G
Last Name:DIAZ
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 1:2501 SW 71ST TER APT 109
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33317-7037
Mailing Address - Country:US
Mailing Address - Phone:787-379-0122
Mailing Address - Fax:
Practice Address - Street 1:2501 SW 71ST TER APT 109
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33317-7037
Practice Address - Country:US
Practice Address - Phone:787-379-0122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program