MEDICARE: DR. SHEILA JOAN JUSTINIANO ROSARIO PHD

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	103TC0700X	Clinical Psychologist	6373	PR

General Provider Information

NPI Number	:	1194377531
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHEILA JOAN JUSTINIANO ROSARIO PHD

Provider Business Mailing Address
First Line	:	223 HORMIGUEROS APARTMENTS
Second Line	:
City	:	HORMIGUEROS
State	:	PR
Zip	:	00660
Country	:	US
Telephone Number	:	787-217-2414
Fax Number	:

Provider Business Practice Location Address
First Line	:	740 AVE HOSTOS STE 308
Second Line	:
City	:	MAYAGUEZ
State	:	PR
Zip	:	00682-1541
Country	:	US
Telephone Number	:	787-217-2414
Fax Number	:

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

Provider Enumeration Date	:	07/16/2019
Last Update Date	:	09/19/2020

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