Individual
MRS. SHEILA P. FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.C.D.,CCC-SLP
Contact information
Practice address
103 INTERCOM DR, SUITE C, MADISON, AL 35758-2640
(256) 464-9464
(256) 325-9469
Mailing address
120 BRICKSTONE PL, MADISON, AL 35756-3498
(256) 617-0203
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2301
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
51536066
BLUE CROSS BLUE SHIELD
AL
01
—
870757392
TRICARE SOUTH REGION
AL
05
—
890017370
—
AL
Enumeration date
01/10/2007
Last updated
02/16/2021
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