Healthcare Provider Details

I. General information

NPI: 1417087966
Provider Name (Legal Business Name): SHEEBA M. PICARD D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHEEBA M. AYLI DO

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 08/11/2020
Certification Date: 08/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 LANGDON STREET
SOMERSET KY
42503-2786
US

IV. Provider business mailing address

PO BOX 1080
BURKESVILLE KY
42717-1080
US

V. Phone/Fax

Practice location:
  • Phone: 606-678-8155
  • Fax: 606-678-7548
Mailing address:
  • Phone: 270-858-6655
  • Fax: 270-858-4607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number34-009766
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number04172
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: