MEDICARE: DR. SHEILA JOYCE EATON PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	6301006308	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0E00067	OTHER	MI	BLUECROSSBLUE SHIELD
2	103641	OTHER	MI	VALUE OPTIONS

General Provider Information

NPI Number	:	1013073121
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHEILA JOYCE EATON PH.D.

Provider Business Mailing Address
First Line	:	31201 CHICAGO RD S
Second Line	:	SUITE A102
City	:	WARREN
State	:	MI
Zip	:	48093-5527
Country	:	US
Telephone Number	:	586-795-4750
Fax Number	:	586-795-4760

Provider Business Practice Location Address
First Line	:	31201 CHICAGO RD S
Second Line	:	SUITE A102
City	:	WARREN
State	:	MI
Zip	:	48093-5527
Country	:	US
Telephone Number	:	586-795-4750
Fax Number	:	586-795-4760

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/01/2007
Last Update Date	:	07/08/2007

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