Provider Demographics
NPI:1013527555
Name:GILBERT, SHEELEY ANDREW
Entity Type:Individual
Prefix:MR
First Name:SHEELEY
Middle Name:ANDREW
Last Name:GILBERT
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 1:505 WILLIAMS ST LOT 93
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82007-3637
Mailing Address - Country:US
Mailing Address - Phone:307-772-1491
Mailing Address - Fax:
Practice Address - Street 1:505 WILLIAMS ST LOT 93
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82007-3637
Practice Address - Country:US
Practice Address - Phone:307-772-1491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-07
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY172V00000X, 175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty
No172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty