Provider Demographics
NPI:1780402636
Name:EALEY, SHERIDAN A
Entity type:Individual
Prefix:
First Name:SHERIDAN
Middle Name:A
Last Name:EALEY
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 1:3712 9TH ST SW STE 1A
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-3564
Mailing Address - Country:US
Mailing Address - Phone:253-880-7004
Mailing Address - Fax:
Practice Address - Street 1:3712 9TH ST SW STE 1A
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-3564
Practice Address - Country:US
Practice Address - Phone:253-880-7004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-30
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA61593321225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist