Provider Demographics
NPI:1972939098
Name:FAIRLESS BAFUS, SHEILAH ARIADNE
Entity Type:Individual
Prefix:
First Name:SHEILAH
Middle Name:ARIADNE
Last Name:FAIRLESS BAFUS
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 1:12881 SW PENINSULA DR
Mailing Address - Street 2:
Mailing Address - City:TERREBONNE
Mailing Address - State:OR
Mailing Address - Zip Code:97760-9082
Mailing Address - Country:US
Mailing Address - Phone:541-550-9939
Mailing Address - Fax:
Practice Address - Street 1:12881 SW PENINSULA DR
Practice Address - Street 2:
Practice Address - City:TERREBONNE
Practice Address - State:OR
Practice Address - Zip Code:97760-9082
Practice Address - Country:US
Practice Address - Phone:541-550-9939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-20
Last Update Date:2013-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide