Provider Demographics
NPI:1851802466
Name:DAIGLE-BEAIRD, SHELIA BERNEADETTE
Entity Type:Individual
Prefix:
First Name:SHELIA
Middle Name:BERNEADETTE
Last Name:DAIGLE-BEAIRD
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 1:4422 N PERSHING AVE
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-6954
Mailing Address - Country:US
Mailing Address - Phone:209-953-8843
Mailing Address - Fax:209-953-8478
Practice Address - Street 1:4422 N PERSHING AVE
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-6954
Practice Address - Country:US
Practice Address - Phone:209-953-8843
Practice Address - Fax:209-953-8478
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-23
Last Update Date:2017-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty