Healthcare Provider Details

I. General information

NPI: 1245401330
Provider Name (Legal Business Name): SHEILA M. GENTILELLA L.M.T
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2008
Last Update Date: 03/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

471 FERN MEADOW LOOP
OCOEE FL
34761-4790
US

IV. Provider business mailing address

471 FERN MEADOW LOOP
OCOEE FL
34761-4790
US

V. Phone/Fax

Practice location:
  • Phone: 407-342-1474
  • Fax:
Mailing address:
  • Phone: 407-342-1474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA-0016941
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: