Healthcare Provider Details

I. General information

NPI: 1104443027
Provider Name (Legal Business Name): SHEILA GRISEL ALICEAALVARADO PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2020
Last Update Date: 06/20/2025
Certification Date: 06/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 PATRIOT BLVD
FORT BUCHANAN PR
00934-4519
US

IV. Provider business mailing address

21 PATRIOT BLVD
FORT BUCHANAN PR
00934-4519
US

V. Phone/Fax

Practice location:
  • Phone: 787-359-7965
  • Fax:
Mailing address:
  • Phone: 787-707-2212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6317
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: