Healthcare Provider Details

I. General information

NPI: 1255519765
Provider Name (Legal Business Name): SHEILA LYNN BARRY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2008
Last Update Date: 02/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1078 ATLANTIC AVE WELNESS CENTER
LONG BEACH CA
90813
US

IV. Provider business mailing address

901 E 10TH ST APT#4
LONG BEACH CA
90813-4715
US

V. Phone/Fax

Practice location:
  • Phone: 562-285-0149
  • Fax:
Mailing address:
  • Phone: 562-253-7264
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberNA
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: