=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679187181
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHEILA LEE DIROCCO APRN, AGCNS-BC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/02/2020
-----------------------------------------------------
Last Update Date | 09/02/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 640 S STATE ST
-----------------------------------------------------
City | DOVER
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19901-3530
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-744-6223
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 26982 MARYDEL RD
-----------------------------------------------------
City | MARYDEL
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21649-1413
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-233-2329
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 364SR0400X
-----------------------------------------------------
Taxonomy Name | Rehabilitation Clinical Nurse Specialist
-----------------------------------------------------
License Number | L1-0024177
-----------------------------------------------------
License Number State | DE
-----------------------------------------------------