Healthcare Provider Details

I. General information

NPI: 1205893500
Provider Name (Legal Business Name): SHEILA BHAGWANDASS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2006
Last Update Date: 08/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 ANNA LOUISE LANE
ROANOKE RAPIDS NC
27870
US

IV. Provider business mailing address

52 ANNA LOUISE LANE
ROANOKE RAPIDS NC
27870
US

V. Phone/Fax

Practice location:
  • Phone: 252-537-6465
  • Fax: 252-535-0951
Mailing address:
  • Phone: 252-537-6465
  • Fax: 252-535-0951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number38443
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier006701019
Identifier TypeMEDICAID
Identifier StateVA
Identifier Issuer
# 2
Identifier15527
Identifier TypeOTHER
Identifier StateNC
Identifier IssuerBC NC
# 3
Identifier139315
Identifier TypeOTHER
Identifier StateVA
Identifier IssuerBC VA
# 4
Identifier8915527
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: