Provider Demographics
NPI:1093460719
Name:DODGE, SHEIL BRANNDALE
Entity Type:Individual
Prefix:
First Name:SHEIL
Middle Name:BRANNDALE
Last Name:DODGE
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 1:12925 2ND AVE SW
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98146-3312
Mailing Address - Country:US
Mailing Address - Phone:206-954-0536
Mailing Address - Fax:
Practice Address - Street 1:12925 2ND AVE SW
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98146-3312
Practice Address - Country:US
Practice Address - Phone:206-954-0536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-21
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula