Provider Demographics
NPI:1477569150
Name:FAY, SHEILA G (MD)
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:G
Last Name:FAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 LILY RD NE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506
Mailing Address - Country:US
Mailing Address - Phone:360-493-4410
Mailing Address - Fax:360-493-5511
Practice Address - Street 1:525 LILY RD NE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506
Practice Address - Country:US
Practice Address - Phone:360-493-4410
Practice Address - Fax:360-493-5511
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00018119208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1112218Medicaid
WA1112218Medicaid
GAB08326Medicare ID - Type Unspecified