Healthcare Provider Details

I. General information

NPI: 1235168006
Provider Name (Legal Business Name): SARA L. SHEAFFER D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 09/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2510 SULWHANON DR.
EVERSON WA
98247
US

IV. Provider business mailing address

PO BOX 157 NOOKSACK COMMUNITY CLINIC
DEMING WA
98244
US

V. Phone/Fax

Practice location:
  • Phone: 360-966-2106
  • Fax: 360-966-2304
Mailing address:
  • Phone: 360-966-2106
  • Fax: 360-966-2304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOP00002104
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: