Provider Demographics
NPI:1174576565
Name:HENDERSON, SHEILA DAWN (DO)
Entity type:Individual
Prefix:
First Name:SHEILA
Middle Name:DAWN
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:580 W BYPASS
Mailing Address - Street 2:SUITE A
Mailing Address - City:ANDALUSIA
Mailing Address - State:AL
Mailing Address - Zip Code:36420-4743
Mailing Address - Country:US
Mailing Address - Phone:334-582-4496
Mailing Address - Fax:334-582-4497
Practice Address - Street 1:580 W BYPASS
Practice Address - Street 2:SUITE A
Practice Address - City:ANDALUSIA
Practice Address - State:AL
Practice Address - Zip Code:36420-4743
Practice Address - Country:US
Practice Address - Phone:334-582-4496
Practice Address - Fax:334-582-4497
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2013-11-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ALDO.756207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL147910Medicaid