Provider Demographics
NPI:1033100144
Name:GARDNER, SHEILA FULTON (MD)
Entity Type:Individual
Prefix:DR
First Name:SHEILA
Middle Name:FULTON
Last Name:GARDNER
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 1:12 UNION AVE
Mailing Address - Street 2:
Mailing Address - City:DELMAR
Mailing Address - State:NY
Mailing Address - Zip Code:12054-1611
Mailing Address - Country:US
Mailing Address - Phone:518-475-0029
Mailing Address - Fax:518-475-0029
Practice Address - Street 1:12 UNION AVE
Practice Address - Street 2:
Practice Address - City:DELMAR
Practice Address - State:NY
Practice Address - Zip Code:12054-1611
Practice Address - Country:US
Practice Address - Phone:518-475-0029
Practice Address - Fax:518-475-0029
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY216989-1207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G93018Medicare UPIN
RA1331Medicare ID - Type Unspecified