Provider Demographics
NPI:1053850651
Name:DOMINGUEZ RAMOS, SHEYLA III (LND)
Entity type:Individual
Prefix:MISS
First Name:SHEYLA
Middle Name:
Last Name:DOMINGUEZ RAMOS
Suffix:III
Gender:F
Credentials:LND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CALLE SAN JOAQUIN ZZ19 MARIOLGA
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00725
Mailing Address - Country:UM
Mailing Address - Phone:787-450-6859
Mailing Address - Fax:
Practice Address - Street 1:CALLE SAN JOAQUIN ZZ 19 MARIOLGA
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PUERTO RICO
Practice Address - Zip Code:00725
Practice Address - Country:UM
Practice Address - Phone:787-450-6859
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-15
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1579133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered