Healthcare Provider Details

I. General information

NPI: 1922368612
Provider Name (Legal Business Name): SHEILA JOAN GATELY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHEILA GATELY GERBARG M.D.

II. Dates (important events)

Enumeration Date: 05/29/2012
Last Update Date: 03/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 W 6TH ST
JACKSONVILLE FL
32206-4324
US

IV. Provider business mailing address

900 UNIVERSITY BLVD N MC-75
JACKSONVILLE FL
32211-5530
US

V. Phone/Fax

Practice location:
  • Phone: 904-253-1040
  • Fax: 904-253-1918
Mailing address:
  • Phone: 904-253-1025
  • Fax: 904-253-1918

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number27178
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number026010
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number104737
License Number StateMO
# 4
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberME126712
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: