Provider Demographics
NPI:1902084825
Name:SEALY, MEGHAN DAWN (ITDS)
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:DAWN
Last Name:SEALY
Suffix:
Gender:F
Credentials:ITDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3409 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-8172
Mailing Address - Country:US
Mailing Address - Phone:850-477-8180
Mailing Address - Fax:850-416-7348
Practice Address - Street 1:3409 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-8172
Practice Address - Country:US
Practice Address - Phone:850-477-8180
Practice Address - Fax:850-416-7348
Is Sole Proprietor?:No
Enumeration Date:2008-02-01
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator