Provider Demographics
NPI:1578380903
Name:LIZ DUQUE, SHEILA
Entity type:Individual
Prefix:
First Name:SHEILA
Middle Name:
Last Name:LIZ DUQUE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2908 W NORTH ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-4243
Mailing Address - Country:US
Mailing Address - Phone:407-705-4521
Mailing Address - Fax:
Practice Address - Street 1:4810 CENTERBROOK CT
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33624-1039
Practice Address - Country:US
Practice Address - Phone:813-418-9038
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-25
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician