Healthcare Provider Details

I. General information

NPI: 1083178313
Provider Name (Legal Business Name): SHEILA BUSH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2019
Last Update Date: 01/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12791 SE 47TH AVE
BELLEVIEW FL
34420
US

IV. Provider business mailing address

12791 SE 47TH AVE
BELLEVIEW FL
34420-5014
US

V. Phone/Fax

Practice location:
  • Phone: 352-347-9122
  • Fax: 352-347-9122
Mailing address:
  • Phone: 352-347-9122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: