Provider Demographics
NPI:1588985121
Name:LEFFALL, SHEILA LORRAINE
Entity type:Individual
Prefix:DR
First Name:SHEILA
Middle Name:LORRAINE
Last Name:LEFFALL
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 1:141 SEAHORSE DR
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94591-7860
Mailing Address - Country:US
Mailing Address - Phone:707-642-6992
Mailing Address - Fax:
Practice Address - Street 1:369 MAIN ST
Practice Address - Street 2:STE 250
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94063-1758
Practice Address - Country:US
Practice Address - Phone:650-369-3399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-17
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47116122300000X, 1223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health
No122300000XDental ProvidersDentist