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General NPI Number Information
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NPI Number | 1699087585
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Entity Type | Organization
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Legal Business Name | SHIELA LOYOLA
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Dates
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Enumeration Date | 07/08/2010
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Last Update Date | 07/08/2010
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Provider Practice Location Address
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Address Line | 5900 W SAMPLE RD UNIT 304
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City | CORAL SPRINGS
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State | FL
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Zip | 33067-3248
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Country | US
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Telephone | 181-831-0252
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Fax |
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Provider Business Mailing Address
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Address Line | 5900 WEST SAMPLE ROAD UNIT 101
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City | CORAL SPRINGS
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State | FL
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Zip | 33067
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Country | US
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Telephone | 181-831-0252
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Fax |
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Authorized Official
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Title or Position | RPT
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Name | MS. SHIELA EDAYA LOYOLA
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Credential |
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Telephone | 18183102525
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 070017759
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License Number State | IL
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