Healthcare Provider Details

I. General information

NPI: 1114981743
Provider Name (Legal Business Name): SHEILA H TIMOTHY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 HIGHLAND PARK DR SUITE 201
UNIONTOWN PA
15401-8926
US

IV. Provider business mailing address

2 HIGHLAND PARK DR SUITE 201
UNIONTOWN PA
15401-8926
US

V. Phone/Fax

Practice location:
  • Phone: 724-439-4479
  • Fax: 724-439-4345
Mailing address:
  • Phone: 724-439-4479
  • Fax: 724-439-4345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD050810L
License Number StatePA

VII. Legacy identifiers

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

# 1
Identifier0014178370003
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: