Provider Demographics
NPI:1245299270
Name:ANDERSON, SHEILA MARIE (DO)
Entity type:Individual
Prefix:
First Name:SHEILA
Middle Name:MARIE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1070 OLD NATIONAL PIKE RD
Mailing Address - Street 2:
Mailing Address - City:FREDERICKTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15333-2114
Mailing Address - Country:US
Mailing Address - Phone:724-632-6801
Mailing Address - Fax:724-632-6312
Practice Address - Street 1:100 WILSON ROAD
Practice Address - Street 2:
Practice Address - City:BENTLEYVILLE
Practice Address - State:PA
Practice Address - Zip Code:15314-1028
Practice Address - Country:US
Practice Address - Phone:724-239-2390
Practice Address - Fax:724-239-2393
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS010327L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018556890004Medicaid
308643OtherUPMC
001324384OtherHIGHMARK
308643OtherUPMC
PA0018556890004Medicaid
001324384OtherHIGHMARK