Provider Demographics
NPI:1871834556
Name:SHEALY, JOHN ANDREW (HIS)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:ANDREW
Last Name:SHEALY
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 DESIREE ST
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71270-7135
Mailing Address - Country:US
Mailing Address - Phone:318-278-9557
Mailing Address - Fax:
Practice Address - Street 1:1101 HUDSON LN
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-6045
Practice Address - Country:US
Practice Address - Phone:318-325-2363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-06
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1221237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist