Provider Demographics
NPI:1407298995
Name:SHEALY, PATRICIA (PHD)
Entity type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:
Last Name:SHEALY
Suffix:
Gender:
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20059 EDGEWATER CT
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32310-8226
Mailing Address - Country:US
Mailing Address - Phone:831-582-7475
Mailing Address - Fax:
Practice Address - Street 1:20059 EDGEWATER CT
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32310-8226
Practice Address - Country:US
Practice Address - Phone:831-582-7475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-24
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT22662106H00000X
CAMFC22662106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL03212025007120OtherMARRIAGE FAMILY THERAPIST
CA1407298995OtherMARRIAGE FAMILY THERAPIST