Provider Demographics
NPI:1326238221
Name:GUTIERREZ SLIGH, HEYDI (MD)
Entity Type:Individual
Prefix:
First Name:HEYDI
Middle Name:
Last Name:GUTIERREZ SLIGH
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:PO BOX 824804
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-4804
Mailing Address - Country:US
Mailing Address - Phone:302-660-7333
Mailing Address - Fax:302-660-7323
Practice Address - Street 1:620 STANTON CHRISTIANA RD
Practice Address - Street 2:SUITE 302
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2133
Practice Address - Country:US
Practice Address - Phone:302-660-7333
Practice Address - Fax:302-660-7323
Is Sole Proprietor?:No
Enumeration Date:2007-07-26
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0009416207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1326238221Medicaid
DE1326238221Medicaid