MEDICARE: DR. SHEILA SEUFERT VERCRUYSSE PH.D.

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	103T00000X	Psychologist	20040130	IN

General Provider Information

NPI Number	:	1710918651
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHEILA SEUFERT VERCRUYSSE PH.D.

Provider Business Mailing Address
First Line	:	1701 LIBRARY BLVD STE E
Second Line	:
City	:	GREENWOOD
State	:	IN
Zip	:	46142-1567
Country	:	US
Telephone Number	:	317-887-6308
Fax Number	:	317-889-5912

Provider Business Practice Location Address
First Line	:	1701 LIBRARY BLVD STE E
Second Line	:
City	:	GREENWOOD
State	:	IN
Zip	:	46142-1567
Country	:	US
Telephone Number	:	317-887-6308
Fax Number	:	317-889-5912

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

Provider Enumeration Date	:	07/06/2006
Last Update Date	:	07/08/2007

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