Healthcare Provider Details

I. General information

NPI: 1114597523
Provider Name (Legal Business Name): SHEILA BUCALO MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2021
Last Update Date: 06/28/2021
Certification Date: 06/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 E SOUTHERN AVE STE G1
TEMPE AZ
85282-7610
US

IV. Provider business mailing address

PO BOX 51081
MESA AZ
85208-0055
US

V. Phone/Fax

Practice location:
  • Phone: 480-409-0322
  • Fax: 877-559-2816
Mailing address:
  • Phone: 480-542-4668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: