Individual
SARA SHEEHAN WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3240 SUNSET BLVD, WEST COLUMBIA, SC 29169-3428
(803) 359-8855
(803) 794-6480
Mailing address
PO BOX 6069, WEST COLUMBIA, SC 29171-6069
(803) 359-8855
(803) 794-6480
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
35809
SC
208000000X
Pediatrics Physician
LL35809
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
35809
SC MEDICAL LICENSE
SC
05
—
358099
—
SC
Enumeration date
06/18/2013
Last updated
12/14/2020
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