Provider Demographics
NPI:1588852651
Name:SHEUFELT, CODY ROBERT
Entity Type:Individual
Prefix:MR
First Name:CODY
Middle Name:ROBERT
Last Name:SHEUFELT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 GUM SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN PINE
Mailing Address - State:AR
Mailing Address - Zip Code:71956-9559
Mailing Address - Country:US
Mailing Address - Phone:501-276-9688
Mailing Address - Fax:
Practice Address - Street 1:251 GUM SPRINGS RD
Practice Address - Street 2:
Practice Address - City:MOUNTAIN PINE
Practice Address - State:AR
Practice Address - Zip Code:71956-9559
Practice Address - Country:US
Practice Address - Phone:501-760-3658
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-13
Last Update Date:2007-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health