Healthcare Provider Details

I. General information

NPI: 1699087585
Provider Name (Legal Business Name): SHIELA LOYOLA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2010
Last Update Date: 07/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5900 W SAMPLE RD UNIT 304
CORAL SPRINGS FL
33067-3248
US

IV. Provider business mailing address

5900 WEST SAMPLE ROAD UNIT 101
CORAL SPRINGS FL
33067
US

V. Phone/Fax

Practice location:
  • Phone: 181-831-0252
  • Fax:
Mailing address:
  • Phone: 181-831-0252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number070017759
License Number StateIL

VIII. Authorized Official

Name: MS. SHIELA EDAYA LOYOLA
Title or Position: RPT
Credential:
Phone: 18183102525