Healthcare Provider Details

I. General information

NPI: 1699785246
Provider Name (Legal Business Name): SHEILA A HADAWAY DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

859 MANKATO AVENUE WINONA CLINIC LTD
WINONA MN
55987
US

IV. Provider business mailing address

859 MANKATO AVENUE WINONA CLINIC LTD
WINONA MN
55987
US

V. Phone/Fax

Practice location:
  • Phone: 507-454-3680
  • Fax: 507-457-7672
Mailing address:
  • Phone: 507-454-3680
  • Fax: 507-457-7672

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number39999
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: