Provider Demographics
NPI:1902036957
Name:SHEELY, DANA MICHELLE FAW (MD)
Entity Type:Individual
Prefix:DR
First Name:DANA
Middle Name:MICHELLE FAW
Last Name:SHEELY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:DANA
Other - Middle Name:MICHELLE
Other - Last Name:FAW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4150 V ST
Mailing Address - Street 2:PSSB SUITE G400
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-1460
Mailing Address - Country:US
Mailing Address - Phone:206-412-4212
Mailing Address - Fax:
Practice Address - Street 1:4860 Y ST
Practice Address - Street 2:STE B0400-ACC
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-2307
Practice Address - Country:US
Practice Address - Phone:206-412-4212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-23
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA111871207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism