Provider Demographics
NPI:1053720417
Name:SHEALY, RALPH MCKEETHA (MD)
Entity type:Individual
Prefix:DR
First Name:RALPH
Middle Name:MCKEETHA
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 1:2719 CODDELL CT
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29466-7930
Mailing Address - Country:US
Mailing Address - Phone:843-224-6484
Mailing Address - Fax:
Practice Address - Street 1:2719 CODDELL CT
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29466-7930
Practice Address - Country:US
Practice Address - Phone:843-224-6484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-10
Last Update Date:2014-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10451207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services