Healthcare Provider Details

I. General information

NPI: 1467442871
Provider Name (Legal Business Name): SHEILA J BROOKS DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 04/15/2009
Certification Date:
Deactivation Date: 10/26/2005
Reactivation Date: 11/08/2005

III. Provider practice location address

324 NORTH ST STE 1
BLUEFIELD WV
24701-4038
US

IV. Provider business mailing address

PO BOX 690
BLUEFIELD WV
24701-0690
US

V. Phone/Fax

Practice location:
  • Phone: 304-325-7079
  • Fax: 304-327-0614
Mailing address:
  • Phone: 304-325-7079
  • Fax: 304-327-0614

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number230
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: