Healthcare Provider Details

I. General information

NPI: 1336172394
Provider Name (Legal Business Name): PHILIPPA M.E SHEDD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 10/28/2020
Certification Date: 10/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 W GOELLER BLVD STE A
COLUMBUS IN
47201-8309
US

IV. Provider business mailing address

PO BOX 775383
CHICAGO IL
60677-5383
US

V. Phone/Fax

Practice location:
  • Phone: 812-375-3330
  • Fax: 812-375-3329
Mailing address:
  • Phone: 812-375-3000
  • Fax: 812-375-3477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01051048
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01051048A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: