Provider Demographics
NPI:1235496084
Name:WHEATLEY, SABRINA CELESHA
Entity Type:Individual
Prefix:MISS
First Name:SABRINA
Middle Name:CELESHA
Last Name:WHEATLEY
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 1:445 E OHIO ST
Mailing Address - Street 2:APARTMENT #2909
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-3302
Mailing Address - Country:US
Mailing Address - Phone:646-696-0539
Mailing Address - Fax:
Practice Address - Street 1:445 E OHIO ST
Practice Address - Street 2:APARTMENT #2909
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-3302
Practice Address - Country:US
Practice Address - Phone:646-696-0539
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-18
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program