1326438227 NPI number — MS. SHEENA MARIE SPURLOCK P.A.

Table of content: MS. SHEENA MARIE SPURLOCK P.A. (NPI 1326438227)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326438227 NPI number — MS. SHEENA MARIE SPURLOCK P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SPURLOCK
Provider First Name:
SHEENA
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
P.A.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DONNELLAN
Provider Other First Name:
SHEENA
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1326438227
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/16/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1065 NE 125TH ST STE 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33161-5833
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-852-6672
Provider Business Mailing Address Fax Number:
786-235-6225

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1065 NE 125TH ST STE 206
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33161-5832
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-891-0050
Provider Business Practice Location Address Fax Number:
305-891-0497
Provider Enumeration Date:
01/29/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  PA9108525 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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