Provider Demographics
NPI:1639227580
Name:OVERTON, SHEILA M (MD)
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:M
Last Name:OVERTON
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 1:13618 NIGHT SKY DR
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906-5802
Mailing Address - Country:US
Mailing Address - Phone:323-854-2684
Mailing Address - Fax:
Practice Address - Street 1:26005 RIDGE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:DAMASCUS
Practice Address - State:MD
Practice Address - Zip Code:20872-1892
Practice Address - Country:US
Practice Address - Phone:301-414-2300
Practice Address - Fax:301-414-2306
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2015-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0071541207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD442135300Medicaid
DC206963ZAK4Medicare PIN
F11818Medicare UPIN