Provider Demographics
NPI:1922368612
Name:GATELY, SHEILA JOAN (MD)
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:JOAN
Last Name:GATELY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SHEILA
Other - Middle Name:GATELY
Other - Last Name:GERBARG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:900 UNIVERSITY BLVD N
Mailing Address - Street 2:MC-75
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32211-5530
Mailing Address - Country:US
Mailing Address - Phone:904-253-1025
Mailing Address - Fax:904-253-1918
Practice Address - Street 1:515 W 6TH ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32206-4324
Practice Address - Country:US
Practice Address - Phone:904-253-1040
Practice Address - Fax:904-253-1918
Is Sole Proprietor?:No
Enumeration Date:2012-05-29
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ27178207V00000X
CT026010207V00000X
MO104737207V00000X
FLME126712207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001260108Medicaid