Provider Demographics
NPI:1083858708
Name:SHEALY, LINDA SMITH (FNP)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:SMITH
Last Name:SHEALY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 NE MEDICAL PARK
Mailing Address - Street 2:SUITE 212
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-6251
Mailing Address - Country:US
Mailing Address - Phone:803-736-0731
Mailing Address - Fax:803-736-0753
Practice Address - Street 1:3000 NE MEDICAL PARK
Practice Address - Street 2:SUITE 212
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-6251
Practice Address - Country:US
Practice Address - Phone:803-736-0731
Practice Address - Fax:803-736-0753
Is Sole Proprietor?:No
Enumeration Date:2009-04-24
Last Update Date:2009-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3830363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily