Provider Demographics
NPI:1255811840
Name:SHEALY, DANIELLE LAUREN (CD (DONA), CPM, LM)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:LAUREN
Last Name:SHEALY
Suffix:
Gender:F
Credentials:CD (DONA), CPM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7296 US HIGHWAY 76
Mailing Address - Street 2:
Mailing Address - City:PROSPERITY
Mailing Address - State:SC
Mailing Address - Zip Code:29127-9461
Mailing Address - Country:US
Mailing Address - Phone:803-364-4366
Mailing Address - Fax:803-364-4367
Practice Address - Street 1:7296 US HIGHWAY 76
Practice Address - Street 2:
Practice Address - City:PROSPERITY
Practice Address - State:SC
Practice Address - Zip Code:29127-9461
Practice Address - Country:US
Practice Address - Phone:803-364-4366
Practice Address - Fax:803-364-4367
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-14
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL10891374J00000X
SC0084176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No374J00000XNursing Service Related ProvidersDoula