Provider Demographics
NPI:1336193739
Name:HEATON-SHEUFELT, JANICE D (MD)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:D
Last Name:HEATON-SHEUFELT
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 1:3100 CHANNEL DR STE 300
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801-7837
Mailing Address - Country:US
Mailing Address - Phone:907-463-4057
Mailing Address - Fax:907-463-6657
Practice Address - Street 1:3100 CHANNEL DR STE 300
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-7837
Practice Address - Country:US
Practice Address - Phone:907-463-4057
Practice Address - Fax:907-463-6657
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2015-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK3847207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD3847Medicaid
AK8EA520Medicare PIN
AKMD3847Medicaid
AK8ED921Medicare PIN
AK8EA523Medicare PIN
AK8EA524Medicare PIN
AK8EA522Medicare PIN
AK8EA521Medicare PIN