Healthcare Provider Details

I. General information

NPI: 1104970177
Provider Name (Legal Business Name): SHEILA M PAUL CMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

732 THIMBLE SHOALS BLVD SUITE 906
NEWPORT NEWS VA
23606-4218
US

IV. Provider business mailing address

217 LINDSAY LANDING LN
YORKTOWN VA
23692-3328
US

V. Phone/Fax

Practice location:
  • Phone: 757-873-0774
  • Fax: 757-873-9776
Mailing address:
  • Phone: 757-898-7565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number0019000639
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: