Provider Demographics
NPI:1336209758
Name:SHEILA C LALLY, DO, PS
Entity Type:Organization
Organization Name:SHEILA C LALLY, DO, PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:CAROLYN
Authorized Official - Last Name:LALLY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:360-697-6547
Mailing Address - Street 1:22180 OLYMPIC COLLEGE WAY NW
Mailing Address - Street 2:SUITE 204
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-6664
Mailing Address - Country:US
Mailing Address - Phone:360-697-6547
Mailing Address - Fax:360-697-9277
Practice Address - Street 1:22180 OLYMPIC COLLEGE WAY NW
Practice Address - Street 2:SUITE 204
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-6664
Practice Address - Country:US
Practice Address - Phone:360-697-6547
Practice Address - Fax:360-697-9277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP00001442204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1089317Medicaid
WA1089317Medicaid
WA8808791Medicare ID - Type Unspecified