Provider Demographics
NPI:1194123414
Name:BLACKWELL, HIS, SHELIA (HIS)
Entity type:Individual
Prefix:MRS
First Name:SHELIA
Middle Name:
Last Name:BLACKWELL, HIS
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2043 OAK HILL RD
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27565-7847
Mailing Address - Country:US
Mailing Address - Phone:919-691-0097
Mailing Address - Fax:
Practice Address - Street 1:2043 OAK HILL RD
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:NC
Practice Address - Zip Code:27565-7847
Practice Address - Country:US
Practice Address - Phone:919-691-0097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-18
Last Update Date:2014-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2101001683237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist