Provider Demographics
NPI:1558890590
Name:SAWYER, SHALEASE (DO)
Entity type:Individual
Prefix:DR
First Name:SHALEASE
Middle Name:
Last Name:SAWYER
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:SHALEASE
Other - Middle Name:
Other - Last Name:ADAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:3 SAINT ELIZABETH BLVD STE 4000
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-1284
Mailing Address - Country:US
Mailing Address - Phone:618-233-5480
Mailing Address - Fax:618-222-4792
Practice Address - Street 1:3 SAINT ELIZABETH BLVD STE 4000
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-1284
Practice Address - Country:US
Practice Address - Phone:618-233-5480
Practice Address - Fax:618-222-4792
Is Sole Proprietor?:No
Enumeration Date:2017-06-04
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0064091207Q00000X
NE1956207Q00000X
IL036.156885207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine