Provider Demographics
NPI:1225028459
Name:LALLY, SHEILA CAROLYN (DO)
Entity Type:Individual
Prefix:DR
First Name:SHEILA
Middle Name:CAROLYN
Last Name:LALLY
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:22180 OLYMPIC COLLEGE WAY NW
Mailing Address - Street 2:SUITE 204
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-6664
Mailing Address - Country:US
Mailing Address - Phone:360-697-6547
Mailing Address - Fax:360-697-9277
Practice Address - Street 1:22180 OLYMPIC COLLEGE WAY NW
Practice Address - Street 2:SUITE 204
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-6664
Practice Address - Country:US
Practice Address - Phone:360-697-6547
Practice Address - Fax:360-697-9277
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAOP00001442208600000X, 204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1089317Medicaid
WAE80868Medicare UPIN
WAG8808791Medicare ID - Type Unspecified