Basic Information
| Provider Information | |||||||||
| NPI: | 1083989339 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ANTONY | ||||||||
| FirstName: | SHEILA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4100 E MISSISSIPPI AVE STE 110 | ||||||||
| Address2: | |||||||||
| City: | GLENDALE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802463051 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3035529522 | ||||||||
| FaxNumber: | 7207297668 | ||||||||
| Practice Location | |||||||||
| Address1: | 3527 MEMORIAL DR UNIT W | ||||||||
| Address2: | |||||||||
| City: | DECATUR | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300322731 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4045734844 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/20/2012 | ||||||||
| LastUpdateDate: | 01/27/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/27/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 53936 | CT | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | DR.0056174 | CO | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 61325 | AZ | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | MD61172776 | WA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207R00000X | 90557 | GA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.