MEDICARE: MS. KAYLA MANDEL SHEETS M.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	170300000X	Genetic Counselor (M.S.)

General Provider Information

NPI Number	:	1033442736
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KAYLA MANDEL SHEETS M.S.

Provider Business Mailing Address
First Line	:	308 S 1200 E
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84102-2653
Country	:	US
Telephone Number	:	801-833-2868
Fax Number	:

Provider Business Practice Location Address
First Line	:	1031 IVES DAIRY RD
Second Line	:	SUITE 228
City	:	N MIAMI BEACH
State	:	FL
Zip	:	33179-2538
Country	:	US
Telephone Number	:	800-245-4363
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/12/2009
Last Update Date	:	09/12/2009

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