Provider Demographics
NPI:1861937690
Name:PHILLIPS, SHEILA
Entity type:Individual
Prefix:
First Name:SHEILA
Middle Name:
Last Name:PHILLIPS
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 1:320 BROOKES DR
Mailing Address - Street 2:
Mailing Address - City:HAZELWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63042-2736
Mailing Address - Country:US
Mailing Address - Phone:314-525-5545
Mailing Address - Fax:314-261-9260
Practice Address - Street 1:320 BROOKES DR
Practice Address - Street 2:
Practice Address - City:HAZELWOOD
Practice Address - State:MO
Practice Address - Zip Code:63042-2736
Practice Address - Country:US
Practice Address - Phone:314-525-5545
Practice Address - Fax:314-261-9260
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-03
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOLC001500109251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health