Provider Demographics
NPI:1770648529
Name:FOSTER, SHEILA
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:
Last Name:FOSTER
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 1:2843 COMMUNITY LN
Mailing Address - Street 2:
Mailing Address - City:HIGH RIDGE
Mailing Address - State:MO
Mailing Address - Zip Code:63049-2337
Mailing Address - Country:US
Mailing Address - Phone:636-677-3473
Mailing Address - Fax:636-677-5480
Practice Address - Street 1:2843 COMMUNITY LN
Practice Address - Street 2:
Practice Address - City:HIGH RIDGE
Practice Address - State:MO
Practice Address - Zip Code:63049-2337
Practice Address - Country:US
Practice Address - Phone:636-677-3473
Practice Address - Fax:636-677-5480
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO002215174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist