Provider Demographics
NPI:1528958014
Name:HEINOLD, LILY MASON
Entity type:Individual
Prefix:
First Name:LILY
Middle Name:MASON
Last Name:HEINOLD
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 1:1440 SW 82ND TER APT 911
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3244
Mailing Address - Country:US
Mailing Address - Phone:843-819-7535
Mailing Address - Fax:
Practice Address - Street 1:1440 SW 82ND TER APT 911
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-3244
Practice Address - Country:US
Practice Address - Phone:843-819-7535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-07
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant