Provider Demographics
NPI:1467530469
Name:SEAL, SHARON B (MS)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:B
Last Name:SEAL
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1817 HEATHERHILL ST
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48183-1910
Mailing Address - Country:US
Mailing Address - Phone:734-282-7991
Mailing Address - Fax:
Practice Address - Street 1:13123 EUREKA RD
Practice Address - Street 2:
Practice Address - City:SOUTHGATE
Practice Address - State:MI
Practice Address - Zip Code:48195-1345
Practice Address - Country:US
Practice Address - Phone:734-282-7991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601000281231H00000X
OHA-01223231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI80-4690878Medicaid
MI64OH226510OtherBCBSM
MIP38090001Medicare PIN