MEDICARE: SHEITAMILI PEREZ CERTIFIED

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	246ZC0007X	Surgical Assistant	189027	FL

General Provider Information

NPI Number	:	1154044519
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHEITAMILI PEREZ CERTIFIED

Provider Business Mailing Address
First Line	:	315 CLEARWATER LN
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34759-4035
Country	:	US
Telephone Number	:	850-319-3945
Fax Number	:

Provider Business Practice Location Address
First Line	:	2400 N ORANGE BLOSSOM TRL
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34744-2306
Country	:	US
Telephone Number	:	407-965-9795
Fax Number	:

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

Provider Enumeration Date	:	09/21/2022
Last Update Date	:	09/21/2022

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