Provider Demographics
NPI:1720361660
Name:VANCE, SHEILA R (PA-C)
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:R
Last Name:VANCE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SHEILA
Other - Middle Name:RAE
Other - Last Name:PETERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 9007
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22906-9007
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:375 FOUR LEAF LN
Practice Address - Street 2:STE 103
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-6905
Practice Address - Country:US
Practice Address - Phone:434-243-6820
Practice Address - Fax:434-244-7594
Is Sole Proprietor?:No
Enumeration Date:2011-09-27
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC001002979363A00000X
VA0110004443363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant