Sara Sheehan Wallace
Pediatrician
3240 Sunset Blvd
West Columbia
, South Carolina 29169-3428
Sara Sheehan Wallace
Pediatrician
3240 Sunset Blvd
West Columbia
, South Carolina 29169-3428
(803) 794-6480
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About
Features
Specialties
- Pediatrician
Languages spoken
- English
Location
First Address
- Sara Sheehan Wallace
- Po Box 6069
- West Columbia, SC
- Zip : 29171-6069
- Fax : (803) 794-6480
- Phone : (803) 359-8855
Second Address
- Sara Sheehan Wallace
- 3240 Sunset Blvd
- West Columbia, SC
- Zip : 29169-3428
- Fax : (803) 794-6480
- Phone : (803) 359-8855
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 208000000X | Pediatrician | 35809 | SC |
| N | 208000000X | Pediatrician | LL35809 | SC |
National Provider Identifier
| NPI | 1003255605 |
|---|---|
| Provider Name | Sara Sheehan Wallace |
| First Address | West Columbia, SC 29171-6069 |
| Second Address | West Columbia, SC 29169-3428 |
| Gender | F |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 18/06/2013 |
| Last Update Date | 14/12/2020 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 35809 | SC MEDICAL LICENSE (01) | SC |
| 358099 | (05) | SC |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.