Healthcare Provider Details

I. General information

NPI: 1588667505
Provider Name (Legal Business Name): SHEILA LYNN ROBERTS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 01/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6400 DUTCHMANS PKWY STE 331
LOUISVILLE KY
40205-3344
US

IV. Provider business mailing address

6400 DUTCHMANS PKWY STE 331
LOUISVILLE KY
40205-3344
US

V. Phone/Fax

Practice location:
  • Phone: 502-896-0835
  • Fax: 502-896-0836
Mailing address:
  • Phone: 502-896-0835
  • Fax: 502-896-0836

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number20567
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: