Healthcare Provider Details

I. General information

NPI: 1396366555
Provider Name (Legal Business Name): SHEELON AGHILI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2020
Last Update Date: 06/16/2021
Certification Date: 06/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 DEKALB AVE
BROOKLYN NY
11201-5311
US

IV. Provider business mailing address

14 DEKALB AVE FL 2
BROOKLYN NY
11201-5311
US

V. Phone/Fax

Practice location:
  • Phone: 718-875-4848
  • Fax:
Mailing address:
  • Phone: 718-875-4848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0110007170
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number025178
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: