Provider Demographics
NPI:1407368137
Name:CLARK, SHEENA
Entity type:Individual
Prefix:
First Name:SHEENA
Middle Name:
Last Name:CLARK
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 1:1411 N FLAGLER DR STE 5600
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-3412
Mailing Address - Country:US
Mailing Address - Phone:561-659-6543
Mailing Address - Fax:561-659-3533
Practice Address - Street 1:1411 N FLAGLER DR STE 5600
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-3412
Practice Address - Country:US
Practice Address - Phone:561-659-6543
Practice Address - Fax:561-659-3533
Is Sole Proprietor?:No
Enumeration Date:2017-11-03
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP135449363L00000X
NM53040363L00000X
FL11020226363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner