MEDICARE: ROBERT ALLEN SHEELY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	17053	MS

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00074718	OTHER	MS	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7431317	OTHER	MS	AETNA
3	753068151	OTHER	MS	1ST CHOICE
4	753068151	OTHER	MS	MS PHYSICIANS CARE NETWOR
5	168390707	OTHER	MS	US DEPT OF LABOR
6	753068151	OTHER	MS	MS HEALTH PARTNERS
7	753068151002	OTHER	MS	TRICARE
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104895028
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT ALLEN SHEELY MD

Provider Business Mailing Address
First Line	:	1220 N SHORE PKWY STE A
Second Line	:
City	:	BRANDON
State	:	MS
Zip	:	39047-6383
Country	:	US
Telephone Number	:	601-829-2939
Fax Number	:	601-829-2995

Provider Business Practice Location Address
First Line	:	1220 N SHORE PKWY STE A
Second Line	:
City	:	BRANDON
State	:	MS
Zip	:	39047-6383
Country	:	US
Telephone Number	:	601-829-2939
Fax Number	:	601-829-2995

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/14/2006
Last Update Date	:	08/18/2020

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Directions to “ ROBERT ALLEN SHEELY MD” Practice Location

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