MEDICARE: SHEILA FONTANILLAS-DURAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	237700000X	Hearing Instrument Specialist	AST1216	FL

General Provider Information

NPI Number	:	1174212856
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHEILA FONTANILLAS-DURAN

Provider Business Mailing Address
First Line	:	415 S CHICKASAW TRL
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32825-7803
Country	:	US
Telephone Number	:	407-264-7407
Fax Number	:

Provider Business Practice Location Address
First Line	:	415 S CHICKASAW TRL
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32825-7803
Country	:	US
Telephone Number	:	407-264-7407
Fax Number	:	407-382-2489

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/08/2023
Last Update Date	:	05/08/2023

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