MEDICARE: SHEILA J EATON PC

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	103TC0700X	Clinical Psychologist	6301006308	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	103641	OTHER	MI	VALUE OPTIONS

General Provider Information

NPI Number	:	1609073527
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHEILA J EATON PC

Provider Business Mailing Address
First Line	:	14444 TALBOT DR
Second Line	:
City	:	WARREN
State	:	MI
Zip	:	48088-7412
Country	:	US
Telephone Number	:	586-498-8583
Fax Number	:

Provider Business Practice Location Address
First Line	:	31201 CHICAGO RD S
Second Line	:	SUITE A102
City	:	WARREN
State	:	MI
Zip	:	48093-5527
Country	:	US
Telephone Number	:	586-795-4750
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SHEILA JOYCE EATON
Credential	:	PH.D.
Telephone Number	:	586-795-4750

Provider Enumeration Date	:	07/03/2007
Last Update Date	:	05/21/2009

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