Provider Demographics
NPI:1700353653
Name:SHEALY, SARA T (RN)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:T
Last Name:SHEALY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 TOOLEBECK RD
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29803-8764
Mailing Address - Country:US
Mailing Address - Phone:803-226-0160
Mailing Address - Fax:803-226-0202
Practice Address - Street 1:1200 TOOLEBECK RD
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29803-8764
Practice Address - Country:US
Practice Address - Phone:803-226-0160
Practice Address - Fax:803-226-0202
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-30
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC80204163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WS0200XNursing Service ProvidersRegistered NurseSchoolGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC80204OtherSTATE LICENSE