Basic Information
Provider Information | |||||||||
NPI: | 1720276892 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | ST. FLEUROSE | ||||||||
FirstName: | SHEILLA | ||||||||
MiddleName: |   | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | PSY.D | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | PIERRE-ANTOINE | ||||||||
OtherFirstName: | SHEILLA | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | PSY.D | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 1065 NE 125TH ST STE 409 | ||||||||
Address2: |   | ||||||||
City: | NORTH MIAMI | ||||||||
State: | FL | ||||||||
PostalCode: | 331615834 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8888526672 | ||||||||
FaxNumber: | 3058914228 | ||||||||
Practice Location | |||||||||
Address1: | 1065 NE 125TH ST STE 206 | ||||||||
Address2: |   | ||||||||
City: | NORTH MIAMI | ||||||||
State: | FL | ||||||||
PostalCode: | 331615832 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8888526672 | ||||||||
FaxNumber: | 3058914228 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/13/2007 | ||||||||
LastUpdateDate: | 06/18/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 06/18/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC2200X | PY7312 | FL | N |   | Behavioral Health & Social Service Providers | Psychologist | Clinical Child & Adolescent | 103TC0700X | PY7312 | FL | Y |   | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.