Provider Demographics
NPI:1043488596
Name:SHEILS, EDWIN KENNETH (PA-C)
Entity Type:Individual
Prefix:
First Name:EDWIN
Middle Name:KENNETH
Last Name:SHEILS
Suffix:
Gender:M
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:PO BOX 648
Mailing Address - Street 2:1208 RIVER STREET
Mailing Address - City:SARATOGA
Mailing Address - State:WY
Mailing Address - Zip Code:82331-0648
Mailing Address - Country:US
Mailing Address - Phone:307-326-8381
Mailing Address - Fax:307-326-5698
Practice Address - Street 1:1208 S RIVER ST
Practice Address - Street 2:
Practice Address - City:SARATOGA
Practice Address - State:WY
Practice Address - Zip Code:82331-0650
Practice Address - Country:US
Practice Address - Phone:307-326-8381
Practice Address - Fax:307-326-5698
Is Sole Proprietor?:No
Enumeration Date:2008-02-19
Last Update Date:2009-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY434363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYW21753Medicare PIN