Healthcare Provider Details
I. General information
NPI: 1013030675
Provider Name (Legal Business Name): SHERYL LYNN GRAVELLE-CAMELO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N
II. Dates (important events)
Enumeration Date: 04/09/2007
Last Update Date: 06/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
427 HARRISON AVE
FRANKLIN NC
28734-2580
US
IV. Provider business mailing address
PO BOX 647
HOPE MILLS NC
28348-0647
US
V. Phone/Fax
- Phone: 828-524-7337
- Fax: 828-369-1340
- Phone: 910-483-7337
- Fax: 910-483-0648
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 208000000X |
| Taxonomy | Pediatrics Physician |
| License Number | 9400065 |
| License Number State | NC |
VII. Legacy identifiers
For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:
| # 1 | |
| Identifier | 1563736 |
| Identifier Type | OTHER |
| Identifier State | NC |
| Identifier Issuer | COVENTRY OF THE CAROLINAS |
| # 2 | |
| Identifier | 295815 |
| Identifier Type | OTHER |
| Identifier State | NC |
| Identifier Issuer | MEDCOST, LLC |
| # 3 | |
| Identifier | FH1101845 |
| Identifier Type | OTHER |
| Identifier State | NC |
| Identifier Issuer | FIRST CAROLINA CARE |
| # 4 | |
| Identifier | 38614 |
| Identifier Type | OTHER |
| Identifier State | NC |
| Identifier Issuer | BCBS OF NC |
| # 5 | |
| Identifier | 89133PK |
| Identifier Type | MEDICAID |
| Identifier State | NC |
| Identifier Issuer | |
| # 6 | |
| Identifier | 5429653 |
| Identifier Type | OTHER |
| Identifier State | NC |
| Identifier Issuer | CIGNA/GREATWEST |
| # 7 | |
| Identifier | 1013030675 |
| Identifier Type | OTHER |
| Identifier State | NC |
| Identifier Issuer | HEALTHNET FEDERAL SERVICES |
| # 8 | |
| Identifier | 1013030675 |
| Identifier Type | OTHER |
| Identifier State | NC |
| Identifier Issuer | HEALTHSMART |
| # 9 | |
| Identifier | 1013030675 |
| Identifier Type | MEDICAID |
| Identifier State | NC |
| Identifier Issuer | |
| # 10 | |
| Identifier | 1294636 |
| Identifier Type | OTHER |
| Identifier State | NC |
| Identifier Issuer | UNITED HEALTHCARE |
| # 11 | |
| Identifier | 1563736 |
| Identifier Type | OTHER |
| Identifier State | NC |
| Identifier Issuer | WELLPATH |
| # 12 | |
| Identifier | 4596541 |
| Identifier Type | OTHER |
| Identifier State | NC |
| Identifier Issuer | COVENTRY NATIONAL - COVENTRY PPO |
| # 13 | |
| Identifier | 1013030675 |
| Identifier Type | OTHER |
| Identifier State | NC |
| Identifier Issuer | DOCTORS DIRECT |
| # 14 | |
| Identifier | 1013030675 |
| Identifier Type | OTHER |
| Identifier State | NC |
| Identifier Issuer | HUMANA |
| # 15 | |
| Identifier | 12350463 |
| Identifier Type | OTHER |
| Identifier State | NC |
| Identifier Issuer | PHCS/MULTIPLAN |
| # 16 | |
| Identifier | 5380016 |
| Identifier Type | OTHER |
| Identifier State | NC |
| Identifier Issuer | AETNA |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone:
