Provider Demographics
NPI:1003890336
Name:REGE, SHEILA D (MD)
Entity Type:Individual
Prefix:MRS
First Name:SHEILA
Middle Name:D
Last Name:REGE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2234 COLONIAL BLVD
Mailing Address - Street 2:ATTN: PAYER CONTRACTINS & RELATIONS DEPT.
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:7379 W DESCHUTES AVE
Practice Address - Street 2:STE 100
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-7900
Practice Address - Country:US
Practice Address - Phone:509-987-1800
Practice Address - Fax:509-987-1808
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2015-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA352422085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8966483OtherCIGNA
WA8209728Medicaid
WAP0000063587OtherMODA HEALTH
WAP01487106OtherRAILROAD MEDICARE
WAG8940656Medicare UPIN
WA8966483OtherCIGNA
F11868Medicare UPIN