MEDICARE: SHEELON AGHILI PA-C

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	363AM0700X	Medical Physician Assistant	0110007170	VA
2	363A00000X	Physician Assistant	025178	NY

General Provider Information

NPI Number	:	1396366555
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHEELON AGHILI PA-C

Provider Business Mailing Address
First Line	:	14 DEKALB AVE FL 2
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11201-5311
Country	:	US
Telephone Number	:	718-875-4848
Fax Number	:

Provider Business Practice Location Address
First Line	:	14 DEKALB AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11201-5311
Country	:	US
Telephone Number	:	718-875-4848
Fax Number	:

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

Provider Enumeration Date	:	04/29/2020
Last Update Date	:	06/16/2021

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Directions to “ SHEELON AGHILI PA-C” Practice Location

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