Provider Demographics
NPI:1912267758
Name:SHEETS, NICHOLAS WAYNE (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:WAYNE
Last Name:SHEETS
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5253 EL CERRITO DR APT 200
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-6280
Mailing Address - Country:US
Mailing Address - Phone:304-389-4211
Mailing Address - Fax:
Practice Address - Street 1:4234 RIVERWALK PKWY STE 120
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92505-3304
Practice Address - Country:US
Practice Address - Phone:951-373-5800
Practice Address - Fax:951-344-8303
Is Sole Proprietor?:No
Enumeration Date:2012-05-28
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1912267782086S0127X
390200000X
CA19122677582086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program