Provider Demographics
NPI:1609199850
Name:MAHER, SHEILA RAE (PA-C)
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:RAE
Last Name:MAHER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18118 6TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:NORMANDY PARK
Mailing Address - State:WA
Mailing Address - Zip Code:98166-3726
Mailing Address - Country:US
Mailing Address - Phone:541-778-2454
Mailing Address - Fax:
Practice Address - Street 1:18118 6TH AVE SW
Practice Address - Street 2:
Practice Address - City:NORMANDY PARK
Practice Address - State:WA
Practice Address - Zip Code:98166-3726
Practice Address - Country:US
Practice Address - Phone:541-778-2454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-02
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA60055291363A00000X, 363AM0700X
CAPA20869363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant