Provider Demographics
NPI:1104895028
Name:SHEELY, ROBERT ALLEN (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:ALLEN
Last Name:SHEELY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1220 N SHORE PKWY STE A
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39047-6383
Mailing Address - Country:US
Mailing Address - Phone:601-829-2939
Mailing Address - Fax:601-829-2995
Practice Address - Street 1:1220 N SHORE PKWY STE A
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:MS
Practice Address - Zip Code:39047-6383
Practice Address - Country:US
Practice Address - Phone:601-829-2939
Practice Address - Fax:601-829-2995
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS17053207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS7431317OtherAETNA
MSP00074718OtherRR MEDICARE
MS753068151Other1ST CHOICE
MS753068151OtherMS PHYSICIANS CARE NETWOR
MS168390707OtherUS DEPT OF LABOR
MS753068151OtherMS HEALTH PARTNERS
MS753068151002OtherTRICARE
MS00126023Medicaid
MS753068151002OtherTRICARE
MS168390707OtherUS DEPT OF LABOR
MS7431317OtherAETNA