Individual
MRS. SHARON LYNN W SHEALY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CFNP
Contact information
Practice address
1000 PINE STREET, VARNVILLE, SC 29944-0969
(803) 943-5228
(803) 943-4591
Mailing address
PO BOX 969, 1000 PINE STREET, VARNVILLE, SC 29944-0969
(803) 943-5228
(803) 943-4591
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
1562
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
57-6000094
FEDERAL TAX ID
SC
01
—
570669239
FEDERAL TAX ID #
SC
05
—
GP0365
—
SC
05
—
RHC013
—
SC
Enumeration date
11/22/2005
Last updated
06/05/2014
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