Provider Demographics
NPI:1154379899
Name:SHEELY, CHRISTINA MARIE (DO)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:MARIE
Last Name:SHEELY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:MARIE
Other - Last Name:DAIGREPONT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1180 SETON PKWY
Mailing Address - Street 2:SUITE 220
Mailing Address - City:KYLE
Mailing Address - State:TX
Mailing Address - Zip Code:78640-6178
Mailing Address - Country:US
Mailing Address - Phone:512-504-0076
Mailing Address - Fax:512-504-0075
Practice Address - Street 1:1180 SETON PKWY
Practice Address - Street 2:SUITE 220
Practice Address - City:KYLE
Practice Address - State:TX
Practice Address - Zip Code:78640-6178
Practice Address - Country:US
Practice Address - Phone:512-504-0086
Practice Address - Fax:888-213-8128
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL5533207X00000X
MI5101015949207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX204301006Medicaid
TX204301005Medicaid
TX204301006Medicaid
TX343565YL9XMedicare PIN
TX204301005Medicaid
TXTXB129667Medicare PIN
TX8F22291Medicare PIN