Provider Demographics
NPI:1316368335
Name:DONNELLY, SHEILA ROSELO (DC)
Entity Type:Individual
Prefix:DR
First Name:SHEILA
Middle Name:ROSELO
Last Name:DONNELLY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:369 JUANA AVE
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577-4810
Mailing Address - Country:US
Mailing Address - Phone:510-316-3917
Mailing Address - Fax:510-357-1365
Practice Address - Street 1:369 JUANA AVE
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-4810
Practice Address - Country:US
Practice Address - Phone:510-316-3917
Practice Address - Fax:510-357-1365
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-17
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 32685111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor