Provider Demographics
NPI:1972133023
Name:SHEALEY, DEBORAH (MDIV; DCC)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:SHEALEY
Suffix:
Gender:F
Credentials:MDIV; DCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4179 INDIAN SPRING RD
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:VA
Mailing Address - Zip Code:23942-2516
Mailing Address - Country:US
Mailing Address - Phone:434-390-3111
Mailing Address - Fax:
Practice Address - Street 1:4179 INDIAN SPRING RD
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:VA
Practice Address - Zip Code:23942-2516
Practice Address - Country:US
Practice Address - Phone:434-390-3111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-16
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health