Provider Demographics
NPI:1679706477
Name:SHEALY, SARAH MARGARET (CNM)
Entity type:Individual
Prefix:MS
First Name:SARAH
Middle Name:MARGARET
Last Name:SHEALY
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1524 YALE ST APT 2
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-3605
Mailing Address - Country:US
Mailing Address - Phone:310-806-0404
Mailing Address - Fax:
Practice Address - Street 1:1524 YALE ST APT 2
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-3605
Practice Address - Country:US
Practice Address - Phone:310-806-0404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-26
Last Update Date:2009-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1289176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife