Healthcare Provider Details

I. General information

NPI: 1649975970
Provider Name (Legal Business Name): VIRGIN ISLANDS DIABETES CENTER OF EXCELLENCE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2023
Last Update Date: 09/29/2023
Certification Date: 09/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4040 ESTATE LA GRANDE PRINCESSE STE 2
CHRISTIANSTED VI
00820-5166
US

IV. Provider business mailing address

4040 ESTATE LA GRANDE PRINCESSE STE 2
CHRISTIANSTED VI
00820-5166
US

V. Phone/Fax

Practice location:
  • Phone: 340-208-0260
  • Fax:
Mailing address:
  • Phone: 340-208-0260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LC1500X
TaxonomyCommunity Health Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State

VIII. Authorized Official

Name: JULIA SHEEN
Title or Position: EXECUTIVE DIRECTOR
Credential: DRPH
Phone: 410-419-3793