Healthcare Provider Details

I. General information

NPI: 1710918651
Provider Name (Legal Business Name): SHEILA SEUFERT VERCRUYSSE PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 LIBRARY BLVD STE E
GREENWOOD IN
46142-1567
US

IV. Provider business mailing address

1701 LIBRARY BLVD STE E
GREENWOOD IN
46142-1567
US

V. Phone/Fax

Practice location:
  • Phone: 317-887-6308
  • Fax: 317-889-5912
Mailing address:
  • Phone: 317-887-6308
  • Fax: 317-889-5912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number20040130
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: