Healthcare Provider Details

I. General information

NPI: 1659376556
Provider Name (Legal Business Name): SHARON KAY MCELHINNEY DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHARON KAY DYKSTRA D.O.

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 05/06/2021
Certification Date: 05/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 W KIMBERLY ROAD DAVENPORT HEALTHPLEX, PEDS
DAVENPORT IA
52806
US

IV. Provider business mailing address

3200 W KIMBERLY ROAD DAVENPORT HEALTHPLEX, PEDS
DAVENPORT IA
52806
US

V. Phone/Fax

Practice location:
  • Phone: 563-421-0010
  • Fax: 563-421-0009
Mailing address:
  • Phone: 563-421-0010
  • Fax: 563-421-0009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number02455
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier5066423
Identifier TypeMEDICAID
Identifier StateIA
Identifier Issuer
# 2
Identifier034796
Identifier TypeOTHER
Identifier State
Identifier IssuerHEALTH ALLIANCE
# 3
Identifier19909
Identifier TypeOTHER
Identifier State
Identifier IssuerIOWA HEALTH SOLUTIONS
# 4
Identifier29771
Identifier TypeOTHER
Identifier StateIA
Identifier IssuerWELLMARK BC/BS
# 5
IdentifierIA0127
Identifier TypeOTHER
Identifier State
Identifier IssuerJOHN DEERE HEALTH PLAN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: