Individual provider Active NPI

Shealy Aghamalian, PA-C

  • Physician Assistant
  • Jacksonville, FL
National Provider Identifier
1750706545
Registry record updated Feb 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA 9107598 Issued in FL
Practice address
841 Prudential Dr Ste 1900
Jacksonville, FL 32207-8373
Phone
(904) 633-0926
NPI assigned
Mar 3, 2014
Last updated
Feb 9, 2024By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 9, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA 9107598 FL Primary

Addresses

Primary practice location

841 Prudential Dr Ste 1900
Jacksonville, FL 32207-8373

Mailing address

841 Prudential Dr Ste 1900
Jacksonville, FL 32207-8373
Phone (904) 633-0926

Other identifiers 1

IdentifierTypeStateIssuer
010876900MedicaidFL

Other names 1

  • Shealy Weeks Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140503000008 FL Practitioner - Physician Assistant 9638302318 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA 9107598FLMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Florida Clinical Practice Association Inc CurrentSince Apr 28, 2014 Accepting new patients
Florida Clinical Practice Association Inc CurrentSince Apr 28, 2014 Accepting new patients
University of Florida Jacksonville Physicians Inc CurrentSince Mar 25, 2019 Accepting new patients
University of Florida Jacksonville Physicians, Inc. CurrentSince Mar 25, 2019 Accepting new patients
The Nemours Foundation Past Accepting new patients
The Nemours Foundation PastSince Feb 11, 2024 Accepting new patients

Locations

1600 SW Archer Rd
Gainesville, FL 32610
Phone (352) 265-0077

1600 SW Archer Rd
#100296
Gainesville, FL 32610
Phone (352) 273-7770

2001 SW 13th St
Gainesville, FL 32608
Phone (352) 265-8990

1443 San Marco Blvd
Jacksonville, FL 32207
Phone (904) 633-4110

Interoperability endpoints

  • Direct secure messaging: sweeks418920@direct.shands.ufl.edu

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1393804800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707436800000",
    "number": "1750706545",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "841 PRUDENTIAL DR STE 1900",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322078373",
            "telephone_number": "904-633-0926"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "841 PRUDENTIAL DR STE 1900",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322078373",
            "telephone_number": "904-633-0926"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AGHAMALIAN",
        "first_name": "SHEALY",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-03-03",
        "last_updated": "2024-02-09",
        "certification_date": "2024-02-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA 9107598",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010876900",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHEALY",
            "last_name": "WEEKS",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.