Healthcare Provider Details

I. General information

NPI: 1518969369
Provider Name (Legal Business Name): JERRY E SHEWARD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2005
Last Update Date: 09/18/2025
Certification Date: 09/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2009 BROWN ST
ANDERSON IN
46016-4216
US

IV. Provider business mailing address

9615 E 148TH ST STE 1
NOBLESVILLE IN
46060-4371
US

V. Phone/Fax

Practice location:
  • Phone: 317-574-1254
  • Fax: 317-674-0060
Mailing address:
  • Phone: 317-587-0500
  • Fax: 317-674-0059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number01032845A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: