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General NPI Number Information
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NPI Number | 1578557153
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Entity Type | Individual
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Provider Name | KEITH D SHEALY M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/09/2005
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Last Update Date | 10/10/2023
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Provider Practice Location Address
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Address Line | 1025 W MEETING ST SUITE 200
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City | LANCASTER
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State | SC
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Zip | 29720-2204
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Country | US
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Telephone | 803-285-7414
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Fax | 803-283-4329
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Provider Business Mailing Address
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Address Line | 1025 W MEETING ST STE 200
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City | LANCASTER
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State | SC
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Zip | 29720-2246
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Country | US
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Telephone | 803-285-7414
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Fax | 803-283-4329
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 10924
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License Number State | SC
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