Provider Demographics
NPI:1770811861
Name:STALEY, SHEILA RUTH (MED)
Entity type:Individual
Prefix:MRS
First Name:SHEILA
Middle Name:RUTH
Last Name:STALEY
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:512 WEST AVE
Mailing Address - Street 2:
Mailing Address - City:JENKINTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19046-2725
Mailing Address - Country:US
Mailing Address - Phone:215-885-1835
Mailing Address - Fax:215-885-8510
Practice Address - Street 1:512 WEST AVE
Practice Address - Street 2:
Practice Address - City:JENKINTOWN
Practice Address - State:PA
Practice Address - Zip Code:19046-2725
Practice Address - Country:US
Practice Address - Phone:215-885-1835
Practice Address - Fax:215-885-8510
Is Sole Proprietor?:No
Enumeration Date:2009-11-30
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health