Provider Demographics
NPI:1427002096
Name:WAYNE HEALY, SHELLEY M (DPM)
Entity type:Individual
Prefix:DR
First Name:SHELLEY
Middle Name:M
Last Name:WAYNE HEALY
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2270 FORD PKWY STE 104
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55116-3412
Mailing Address - Country:US
Mailing Address - Phone:651-698-8879
Mailing Address - Fax:
Practice Address - Street 1:2270 FORD PKWY STE 104
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55116-3412
Practice Address - Country:US
Practice Address - Phone:651-698-8879
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN915213E00000X
TX1593213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
4791770001Medicare NSC
TXU91234Medicare UPIN