Provider Demographics
NPI:1467442871
Name:BROOKS, SHEILA J (DPM)
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:J
Last Name:BROOKS
Suffix:
Gender:F
Credentials:DPM
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 690
Mailing Address - Street 2:
Mailing Address - City:BLUEFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:24701-0690
Mailing Address - Country:US
Mailing Address - Phone:304-325-7079
Mailing Address - Fax:304-327-0614
Practice Address - Street 1:324 NORTH ST STE 1
Practice Address - Street 2:
Practice Address - City:BLUEFIELD
Practice Address - State:WV
Practice Address - Zip Code:24701-4038
Practice Address - Country:US
Practice Address - Phone:304-325-7079
Practice Address - Fax:304-327-0614
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-26
Last Update Date:2009-04-15
Deactivation Date:2005-10-26
Deactivation Code:
Reactivation Date:2005-11-08
Provider Licenses
StateLicense IDTaxonomies
WV230213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810011431Medicaid
WV0711490001Medicare NSC
WVT89968Medicare UPIN
WV9374421Medicare PIN