Healthcare Provider Details

I. General information

NPI: 1528118510
Provider Name (Legal Business Name): SHEILLAH C GENTILE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 MAIN ST SUITE 2E
DYER IN
46311-1234
US

IV. Provider business mailing address

1001 MAIN ST SUITE 2E
DYER IN
46311-1234
US

V. Phone/Fax

Practice location:
  • Phone: 219-865-9160
  • Fax: 219-865-9251
Mailing address:
  • Phone: 219-865-9160
  • Fax: 219-865-9251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01050311A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: