Provider Demographics
NPI:1447689955
Name:DAUGHERTY, SHEILA
Entity type:Individual
Prefix:
First Name:SHEILA
Middle Name:
Last Name:DAUGHERTY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 ROBESON ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28305-5640
Mailing Address - Country:US
Mailing Address - Phone:910-223-2525
Mailing Address - Fax:910-223-1528
Practice Address - Street 1:1613 WALNUT ST
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-5928
Practice Address - Country:US
Practice Address - Phone:919-535-8758
Practice Address - Fax:919-535-3271
Is Sole Proprietor?:No
Enumeration Date:2013-11-05
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13950225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist