Provider Demographics
NPI:1447259551
Name:EL-SHIEKH, BRENDA A (M D)
Entity type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:A
Last Name:EL-SHIEKH
Suffix:
Gender:F
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6126
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42702-6126
Mailing Address - Country:US
Mailing Address - Phone:270-769-1100
Mailing Address - Fax:270-769-8688
Practice Address - Street 1:1320 WOODLAND DR
Practice Address - Street 2:SUITE A
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-3652
Practice Address - Country:US
Practice Address - Phone:270-769-1100
Practice Address - Fax:270-737-8688
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-20
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY36492207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1447259551OtherWINDSOR STERLING
KY000000213980OtherANTHEM
KY1447259551OtherWINDSOR STERLING
1891201Medicare PIN