Healthcare Provider Details

I. General information

NPI: 1538169354
Provider Name (Legal Business Name): NEAL L. SHEALY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2005
Last Update Date: 04/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 PINE STREET
VARNVILLE SC
29944-0969
US

IV. Provider business mailing address

1000 PINE ST
VARNVILLE SC
29944-0969
US

V. Phone/Fax

Practice location:
  • Phone: 803-943-5228
  • Fax: 803-943-4591
Mailing address:
  • Phone: 803-943-5228
  • Fax: 803-943-4591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number9844
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number9844
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: