Provider Demographics
NPI:1033156542
Name:SHEILA DAWN HENDERSON, DO, PA
Entity Type:Organization
Organization Name:SHEILA DAWN HENDERSON, DO, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO, PA
Authorized Official - Phone:941-764-6645
Mailing Address - Street 1:2300 LOVELAND BLVD
Mailing Address - Street 2:STE. 1
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33980
Mailing Address - Country:US
Mailing Address - Phone:941-764-6645
Mailing Address - Fax:941-764-0391
Practice Address - Street 1:2300 LOVELAND BLVD
Practice Address - Street 2:STE. 1
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33980
Practice Address - Country:US
Practice Address - Phone:941-764-6645
Practice Address - Fax:941-764-0391
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS8343207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL269511100Medicaid
FL37960OtherBLUE CROSS
FL37960OtherBLUE CROSS