Provider Demographics
NPI:1518184803
Name:IRICK, SHIELA LYN (MD)
Entity Type:Individual
Prefix:
First Name:SHIELA
Middle Name:LYN
Last Name:IRICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11950 FISHERS CROSSING DR
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-2702
Mailing Address - Country:US
Mailing Address - Phone:317-595-5555
Mailing Address - Fax:317-595-5554
Practice Address - Street 1:11950 FISHERS CROSSING DR
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-2702
Practice Address - Country:US
Practice Address - Phone:317-595-5555
Practice Address - Fax:317-595-5554
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01041584A2084P0015X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0015XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychosomatic Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ING77925Medicare UPIN