Healthcare Provider Details

I. General information

NPI: 1144302860
Provider Name (Legal Business Name): JILL MARIE SHEILS PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JILL MARIE LAURICELLA

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 06/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 SW 84TH AVE SUITE C
PLANTATION FL
33324-2715
US

IV. Provider business mailing address

7351 W OAKLAND PARK BLVD SUITE 106
TAMARAC FL
33319-7107
US

V. Phone/Fax

Practice location:
  • Phone: 954-370-8585
  • Fax:
Mailing address:
  • Phone: 954-749-6955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9107683
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: