Provider Demographics
NPI:1164153300
Name:HEALEY, SHELBY SARRADET (DDS)
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:SARRADET
Last Name:HEALEY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11728 DECADE CT
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20191-2942
Mailing Address - Country:US
Mailing Address - Phone:512-363-0215
Mailing Address - Fax:
Practice Address - Street 1:9360 RICHMOND HWY
Practice Address - Street 2:
Practice Address - City:LORTON
Practice Address - State:VA
Practice Address - Zip Code:22079-1827
Practice Address - Country:US
Practice Address - Phone:703-495-9992
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-20
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALD-0007077-C11223G0001X
TX394261223G0001X
VA04014192081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice