Provider Demographics
NPI:1609073527
Name:SHEILA J EATON PC
Entity Type:Organization
Organization Name:SHEILA J EATON PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:JOYCE
Authorized Official - Last Name:EATON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:586-795-4750
Mailing Address - Street 1:14444 TALBOT DR
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48088-7412
Mailing Address - Country:US
Mailing Address - Phone:586-498-8583
Mailing Address - Fax:
Practice Address - Street 1:31201 CHICAGO RD S
Practice Address - Street 2:SUITE A102
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-5527
Practice Address - Country:US
Practice Address - Phone:586-795-4750
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-03
Last Update Date:2009-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301006308103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI103641OtherVALUE OPTIONS
MI0P08320001Medicare PIN
MI103641OtherVALUE OPTIONS