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General NPI Number Information
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NPI Number | 1154386001
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Entity Type | Individual
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Provider Name | SHEILA M CAVALLARO PAC
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Gender | Female
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Dates
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Enumeration Date | 04/20/2006
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Last Update Date | 10/14/2020
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Provider Practice Location Address
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Address Line | 20520 KEOKUK AVE STE 104
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City | LAKEVILLE
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State | MN
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Zip | 55044-6085
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Country | US
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Telephone | 952-469-5033
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Fax | 952-469-5069
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Provider Business Mailing Address
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Address Line | 20520 KEOKUK AVE STE 104
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City | LAKEVILLE
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State | MN
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Zip | 55044-6085
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Country | US
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Telephone | 952-469-5033
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Fax | 952-469-5069
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 9897
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License Number State | MN
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