Provider Demographics
NPI:1538169354
Name:SHEALY, NEAL L (MD)
Entity type:Individual
Prefix:DR
First Name:NEAL
Middle Name:L
Last Name:SHEALY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 PINE ST
Mailing Address - Street 2:
Mailing Address - City:VARNVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29944-0969
Mailing Address - Country:US
Mailing Address - Phone:803-943-5228
Mailing Address - Fax:803-943-4591
Practice Address - Street 1:1000 PINE STREET
Practice Address - Street 2:
Practice Address - City:VARNVILLE
Practice Address - State:SC
Practice Address - Zip Code:29944-0969
Practice Address - Country:US
Practice Address - Phone:803-943-5228
Practice Address - Fax:803-943-4591
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2013-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9844208M00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCRHC013Medicaid
SC570669239OtherGROUP INSURANCE
SCGP0365Medicaid
SC098441Medicaid
SC423820Medicare Oscar/Certification
SCC813629044Medicare UPIN
SCRHC013Medicaid