Healthcare Provider Details

I. General information

NPI: 1083020408
Provider Name (Legal Business Name): SHEENA L. URDAZ PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2014
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1094 MILITARY TRL
JUPITER FL
33458-7021
US

IV. Provider business mailing address

PO BOX 850001, DEPT 8340
ORLANDO FL
32885-0001
US

V. Phone/Fax

Practice location:
  • Phone: 561-622-6111
  • Fax: 855-215-9930
Mailing address:
  • Phone: 813-536-7277
  • Fax: 855-830-1722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number9108922
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: