Healthcare Provider Details

I. General information

NPI: 1245291426
Provider Name (Legal Business Name): SHEILA IVETTE CARBONELL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 11/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16060 NW 83RD PL
MIAMI LAKES FL
33016-6736
US

IV. Provider business mailing address

16060 NW 83RD PL
MIAMI LAKES FL
33016-6736
US

V. Phone/Fax

Practice location:
  • Phone: 786-216-9960
  • Fax:
Mailing address:
  • Phone: 786-216-9960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number225752
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberME96216
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: