Provider Demographics
NPI:1396519708
Name:SHEALY, SADECA SAMAY
Entity type:Individual
Prefix:
First Name:SADECA
Middle Name:SAMAY
Last Name:SHEALY
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 1:3385 E 139TH ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44120-3969
Mailing Address - Country:US
Mailing Address - Phone:513-904-0187
Mailing Address - Fax:
Practice Address - Street 1:3520 E 140TH ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44120-4547
Practice Address - Country:US
Practice Address - Phone:513-904-0187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-07
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty