Provider Demographics
NPI:1316945710
Name:VILLAMOR, SHELAILA N (DO)
Entity type:Individual
Prefix:DR
First Name:SHELAILA
Middle Name:N
Last Name:VILLAMOR
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:SHELAILA
Other - Middle Name:NADAL
Other - Last Name:NERI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1023 CREEKSIDE MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:SC
Mailing Address - Zip Code:29745-8624
Mailing Address - Country:US
Mailing Address - Phone:803-684-3738
Mailing Address - Fax:803-684-3808
Practice Address - Street 1:1023 CREEKSIDE MEDICAL DR
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:SC
Practice Address - Zip Code:29745-8624
Practice Address - Country:US
Practice Address - Phone:803-684-3738
Practice Address - Fax:803-684-3808
Is Sole Proprietor?:No
Enumeration Date:2005-07-09
Last Update Date:2014-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC0738207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC007389Medicaid
SCH29406 (7180) (7366)Medicare ID - Type Unspecified
SC007389Medicaid