Provider Demographics
NPI:1003000712
Name:MALLORY, SHEILA ORALLO (N P)
Entity Type:Individual
Prefix:MS
First Name:SHEILA
Middle Name:ORALLO
Last Name:MALLORY
Suffix:
Gender:F
Credentials:N P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1867 E FIR AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3841
Mailing Address - Country:US
Mailing Address - Phone:559-325-5876
Mailing Address - Fax:559-325-5838
Practice Address - Street 1:1867 E FIR AVE STE 104
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3841
Practice Address - Country:US
Practice Address - Phone:559-325-5876
Practice Address - Fax:559-325-5838
Is Sole Proprietor?:No
Enumeration Date:2007-09-06
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11495363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily