Provider Demographics
NPI:1184017931
Name:OLIVER, SHEILA
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:
Last Name:OLIVER
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 1:132 MEREDITH AVE
Mailing Address - Street 2:
Mailing Address - City:NEDROW
Mailing Address - State:NY
Mailing Address - Zip Code:13120-1119
Mailing Address - Country:US
Mailing Address - Phone:315-766-5465
Mailing Address - Fax:315-492-2758
Practice Address - Street 1:132 MEREDITH AVE
Practice Address - Street 2:
Practice Address - City:NEDROW
Practice Address - State:NY
Practice Address - Zip Code:13120-1119
Practice Address - Country:US
Practice Address - Phone:315-766-5465
Practice Address - Fax:315-492-2758
Is Sole Proprietor?:No
Enumeration Date:2015-03-17
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY845775075172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver