Provider Demographics
NPI:1629544820
Name:MAHLER, SHEALYN MICHELLE
Entity Type:Individual
Prefix:
First Name:SHEALYN
Middle Name:MICHELLE
Last Name:MAHLER
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 1:213 CORREAS ST
Mailing Address - Street 2:
Mailing Address - City:HALF MOON BAY
Mailing Address - State:CA
Mailing Address - Zip Code:94019-1873
Mailing Address - Country:US
Mailing Address - Phone:831-254-6162
Mailing Address - Fax:
Practice Address - Street 1:213 CORREAS ST
Practice Address - Street 2:
Practice Address - City:HALF MOON BAY
Practice Address - State:CA
Practice Address - Zip Code:94019-1873
Practice Address - Country:US
Practice Address - Phone:831-254-6162
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-16
Last Update Date:2018-12-04
Deactivation Date:2018-11-03
Deactivation Code:
Reactivation Date:2018-11-28
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician