Provider Demographics
NPI:1679517445
Name:PERTILLER, SHEILA DENEEN (MD)
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:DENEEN
Last Name:PERTILLER
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 1:1559 SPARTA ST
Mailing Address - Street 2:
Mailing Address - City:MC MINNVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37110-1316
Mailing Address - Country:US
Mailing Address - Phone:931-815-4212
Mailing Address - Fax:931-815-4718
Practice Address - Street 1:1559 SPARTA ST
Practice Address - Street 2:
Practice Address - City:MC MINNVILLE
Practice Address - State:TN
Practice Address - Zip Code:37110-1316
Practice Address - Country:US
Practice Address - Phone:931-815-4212
Practice Address - Fax:931-815-4718
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN037210207R00000X
TN37210208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN037210OtherMD LICENSE
TNH85815Medicare UPIN