Healthcare Provider Details

I. General information

NPI: 1104733567
Provider Name (Legal Business Name): SHAYLA RILEY-DORSEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 PARK AVE
ORANGE PARK FL
32073-3132
US

IV. Provider business mailing address

6650 CORPORATE CENTER PKWY APT 1510
JACKSONVILLE FL
32216-8719
US

V. Phone/Fax

Practice location:
  • Phone: 904-862-7130
  • Fax:
Mailing address:
  • Phone: 229-539-1177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: