Provider Demographics
NPI:1497909410
Name:SHEALY, CLYDE NORMAN (MD)
Entity Type:Individual
Prefix:DR
First Name:CLYDE
Middle Name:NORMAN
Last Name:SHEALY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5607 S. 222ND RD
Mailing Address - Street 2:
Mailing Address - City:FAIR GROVE
Mailing Address - State:MO
Mailing Address - Zip Code:65648
Mailing Address - Country:US
Mailing Address - Phone:417-267-2900
Mailing Address - Fax:417-267-3911
Practice Address - Street 1:5607 S 222ND RD
Practice Address - Street 2:
Practice Address - City:FAIR GROVE
Practice Address - State:MO
Practice Address - Zip Code:65648-8192
Practice Address - Country:US
Practice Address - Phone:417-267-2900
Practice Address - Fax:417-267-3911
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-05
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR6A47207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery