Provider Demographics
NPI:1053443531
Name:CLARK, SHEILA JOYCE (MD)
Entity Type:Individual
Prefix:DR
First Name:SHEILA
Middle Name:JOYCE
Last Name:CLARK
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 1:31815 EAGLE RIVER RD
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-9750
Mailing Address - Country:US
Mailing Address - Phone:907-696-5766
Mailing Address - Fax:
Practice Address - Street 1:207 E NORTHERN LIGHTS BLVD
Practice Address - Street 2:STE 111
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-2728
Practice Address - Country:US
Practice Address - Phone:907-272-1892
Practice Address - Fax:907-272-0962
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK28232084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD84482Medicaid
AKMD84482Medicaid