Provider Demographics
NPI:1508487711
Name:FLOOD, SHEILA C
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:C
Last Name:FLOOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2803 MEDICAL CAMPUS DRIVE
Mailing Address - Street 2:
Mailing Address - City:SJAFB
Mailing Address - State:NC
Mailing Address - Zip Code:27531-2311
Mailing Address - Country:US
Mailing Address - Phone:919-722-1933
Mailing Address - Fax:
Practice Address - Street 1:2803 MEDICAL CAMPUS DRIVE
Practice Address - Street 2:
Practice Address - City:SJAFB
Practice Address - State:NC
Practice Address - Zip Code:27531-2311
Practice Address - Country:US
Practice Address - Phone:919-722-1933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-28
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MND14464122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program