Provider Demographics
NPI:1205893500
Name:BHAGWANDASS, SHEILA (MD)
Entity type:Individual
Prefix:MRS
First Name:SHEILA
Middle Name:
Last Name:BHAGWANDASS
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 1:52 ANNA LOUISE LANE
Mailing Address - Street 2:
Mailing Address - City:ROANOKE RAPIDS
Mailing Address - State:NC
Mailing Address - Zip Code:27870
Mailing Address - Country:US
Mailing Address - Phone:252-537-6465
Mailing Address - Fax:252-535-0951
Practice Address - Street 1:52 ANNA LOUISE LANE
Practice Address - Street 2:
Practice Address - City:ROANOKE RAPIDS
Practice Address - State:NC
Practice Address - Zip Code:27870
Practice Address - Country:US
Practice Address - Phone:252-537-6465
Practice Address - Fax:252-535-0951
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-28
Last Update Date:2011-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC38443208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006701019Medicaid
NC15527OtherBC NC
VA139315OtherBC VA
NC8915527Medicaid
NC15527OtherBC NC