Healthcare Provider Details

I. General information

NPI: 1336209758
Provider Name (Legal Business Name): SHEILA C LALLY, DO, PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 01/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22180 OLYMPIC COLLEGE WAY NW SUITE 204
POULSBO WA
98370-6664
US

IV. Provider business mailing address

22180 OLYMPIC COLLEGE WAY NW SUITE 204
POULSBO WA
98370-6664
US

V. Phone/Fax

Practice location:
  • Phone: 360-697-6547
  • Fax: 360-697-9277
Mailing address:
  • Phone: 360-697-6547
  • Fax: 360-697-9277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License NumberOP00001442
License Number StateWA

VIII. Authorized Official

Name: DR. SHEILA CAROLYN LALLY
Title or Position: OWNER
Credential: DO
Phone: 360-697-6547