Provider Demographics
NPI:1558858605
Name:DUNN, SHEILA RENEE HARRIS
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:RENEE HARRIS
Last Name:DUNN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 272
Mailing Address - Street 2:
Mailing Address - City:MINERAL
Mailing Address - State:VA
Mailing Address - Zip Code:23117-0272
Mailing Address - Country:US
Mailing Address - Phone:304-809-1051
Mailing Address - Fax:
Practice Address - Street 1:471 THACKER RD
Practice Address - Street 2:
Practice Address - City:MINERAL
Practice Address - State:VA
Practice Address - Zip Code:23117-3910
Practice Address - Country:US
Practice Address - Phone:304-809-1051
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-15
Last Update Date:2018-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235500000X, 246RP1900X
VA04128886246RM2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RM2200XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyMedical Laboratory
No235500000XSpeech, Language and Hearing Service ProvidersSpecialist/Technologist
No246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy