Provider Demographics
NPI:1487687752
Name:PRAHALAD, SHEELA S (MD)
Entity Type:Individual
Prefix:DR
First Name:SHEELA
Middle Name:S
Last Name:PRAHALAD
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 1:319 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:CLARKS SUMMIT
Mailing Address - State:PA
Mailing Address - Zip Code:18411-1059
Mailing Address - Country:US
Mailing Address - Phone:570-586-6087
Mailing Address - Fax:570-586-6072
Practice Address - Street 1:319 N STATE ST
Practice Address - Street 2:
Practice Address - City:CLARKS SUMMIT
Practice Address - State:PA
Practice Address - Zip Code:18411-1059
Practice Address - Country:US
Practice Address - Phone:570-586-6087
Practice Address - Fax:570-586-6072
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD 038374 E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine