Provider Demographics
NPI:1538184742
Name:DAVIS, SHEILA SANDUBRAE (APN, LPC)
Entity type:Individual
Prefix:
First Name:SHEILA
Middle Name:SANDUBRAE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:APN, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1281
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:WY
Mailing Address - Zip Code:83001-1281
Mailing Address - Country:US
Mailing Address - Phone:307-733-5227
Mailing Address - Fax:
Practice Address - Street 1:830 UPPER CACHE CREEK DR.
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:WY
Practice Address - Zip Code:83001-1281
Practice Address - Country:US
Practice Address - Phone:307-733-5227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY259101YM0800X
MI101062163WP0809X
WY8459363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY000156000OtherMIS
WY110958800Medicaid
WY303551OtherBC/BS
ID8056871000Medicaid
WY169719OtherMHN
WY308004OtherMAGELLAN
WY303551OtherBC/BS