Provider Demographics
NPI:1306839261
Name:SHEINKOPF, SHIRLEY JEANETTE (MD)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:JEANETTE
Last Name:SHEINKOPF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SHIRLEY
Other - Middle Name:JEANETTE
Other - Last Name:SHEINKOPF
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:5406 W GLENN DR
Mailing Address - Street 2:#6
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85301-2662
Mailing Address - Country:US
Mailing Address - Phone:623-934-0245
Mailing Address - Fax:623-934-0428
Practice Address - Street 1:5406 W GLENN DR
Practice Address - Street 2:#6
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85301-2662
Practice Address - Country:US
Practice Address - Phone:623-934-0245
Practice Address - Fax:623-934-0428
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10039208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ272740Medicaid