Provider Demographics
NPI:1326274333
Name:SHEALY, LYNDA NYCOLE (DPT)
Entity Type:Individual
Prefix:DR
First Name:LYNDA
Middle Name:NYCOLE
Last Name:SHEALY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1910 TOWNE CENTRE BLVD
Mailing Address - Street 2:APT 625
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-3598
Mailing Address - Country:US
Mailing Address - Phone:310-345-0022
Mailing Address - Fax:
Practice Address - Street 1:1217 W FAYETTE ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21223-1938
Practice Address - Country:US
Practice Address - Phone:410-727-3947
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-04
Last Update Date:2009-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD21872225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist