Provider Demographics
NPI:1003946005
Name:SHEELY, MARY ANN
Entity Type:Individual
Prefix:
First Name:MARY ANN
Middle Name:
Last Name:SHEELY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1641 E OSBORN RD
Mailing Address - Street 2:STE 1
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-7146
Mailing Address - Country:US
Mailing Address - Phone:602-265-4124
Mailing Address - Fax:602-248-8843
Practice Address - Street 1:930 W SOUTHERN AVE
Practice Address - Street 2:STE 10
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-4938
Practice Address - Country:US
Practice Address - Phone:480-835-0857
Practice Address - Fax:480-898-0138
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ571225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ770075Medicaid