Provider Demographics
NPI:1649975970
Name:VIRGIN ISLANDS DIABETES CENTER OF EXCELLENCE INC
Entity type:Organization
Organization Name:VIRGIN ISLANDS DIABETES CENTER OF EXCELLENCE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEEN
Authorized Official - Suffix:
Authorized Official - Credentials:DRPH
Authorized Official - Phone:410-419-3793
Mailing Address - Street 1:4040 ESTATE LA GRANDE PRINCESSE STE 2
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSTED
Mailing Address - State:VI
Mailing Address - Zip Code:00820-5166
Mailing Address - Country:US
Mailing Address - Phone:340-208-0260
Mailing Address - Fax:
Practice Address - Street 1:4040 ESTATE LA GRANDE PRINCESSE STE 2
Practice Address - Street 2:
Practice Address - City:CHRISTIANSTED
Practice Address - State:VI
Practice Address - Zip Code:00820-5166
Practice Address - Country:US
Practice Address - Phone:340-208-0260
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-04
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
No363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity HealthGroup - Multi-Specialty