Provider Demographics
NPI:1417087966
Name:PICARD, SHEEBA M (DO)
Entity Type:Individual
Prefix:DR
First Name:SHEEBA
Middle Name:M
Last Name:PICARD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:SHEEBA
Other - Middle Name:M
Other - Last Name:AYLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 1080
Mailing Address - Street 2:
Mailing Address - City:BURKESVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42717-1080
Mailing Address - Country:US
Mailing Address - Phone:270-858-6655
Mailing Address - Fax:270-858-4607
Practice Address - Street 1:350 LANGDON STREET
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503-2786
Practice Address - Country:US
Practice Address - Phone:606-678-8155
Practice Address - Fax:606-678-7548
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-009766208000000X
KY04172208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100499590Medicaid