Provider Demographics
NPI:1891302618
Name:SHEELY, BONNIE JEAN
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:JEAN
Last Name:SHEELY
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 1:1799 ROCK CLIFF DR
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25401-2877
Mailing Address - Country:US
Mailing Address - Phone:304-264-8957
Mailing Address - Fax:
Practice Address - Street 1:17 COTTAGE RD APT 122
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25404-9649
Practice Address - Country:US
Practice Address - Phone:304-671-9737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-25
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant