Individual
SHEILA M CAVALLARO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
20520 KEOKUK AVE STE 104, LAKEVILLE, MN 55044-6085
(952) 469-5033
(952) 469-5069
Mailing address
20520 KEOKUK AVE STE 104, LAKEVILLE, MN 55044-6085
(952) 469-5033
(952) 469-5069
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
9897
MN
363A00000X
Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0119269
SELECT CARE
MN
01
—
1042141
PREFERRED ONE
MN
01
—
132409
UCARE
MN
05
—
231912800
—
MN
01
—
352L5BE
BLUES
MN
01
—
HP47685
GROUP HEALTH
MN
Enumeration date
04/20/2006
Last updated
10/14/2020
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