Provider Demographics
NPI:1497808000
Name:DILLARD, SHEILA (MD)
Entity Type:Individual
Prefix:DR
First Name:SHEILA
Middle Name:
Last Name:DILLARD
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 1:2101 HIGHWAY 90
Mailing Address - Street 2:
Mailing Address - City:GAUTIER
Mailing Address - State:MS
Mailing Address - Zip Code:39553-5340
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2809 DENNY AVE
Practice Address - Street 2:
Practice Address - City:PASCAGOULA
Practice Address - State:MS
Practice Address - Zip Code:39581-5301
Practice Address - Country:US
Practice Address - Phone:228-588-2938
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ55309207Q00000X
NV17501207Q00000X
COCDR.00000037207Q00000X
MTMED-PHYS-LIC-60287207Q00000X
IL036.144854207Q00000X
TXR7982207Q00000X
MN63182207Q00000X
TN56006207Q00000X
WV27807207Q00000X
CA151474207Q00000X
MS16435207Q00000X
IAMD-44552207Q00000X
KS04-40312207Q00000X
WI15-320207Q00000X
AL21294207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0120851Medicaid
G81765Medicare UPIN
080003353Medicare ID - Type Unspecified