Provider Demographics
NPI:1154382646
Name:SHEFFIELD, KELLI R (PA C)
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:R
Last Name:SHEFFIELD
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 ASHWOOD CT
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27455-3005
Mailing Address - Country:US
Mailing Address - Phone:336-282-1414
Mailing Address - Fax:336-282-1515
Practice Address - Street 1:1900 ASHWOOD CT
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27455-3005
Practice Address - Country:US
Practice Address - Phone:336-282-1414
Practice Address - Fax:336-282-1515
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-01
Last Update Date:2010-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012273-1363A00000X
NC103649363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2757911Medicare PIN
P84476Medicare UPIN