Provider Demographics
NPI:1124088349
Name:KELLEHER, SHERYL (NP)
Entity type:Individual
Prefix:
First Name:SHERYL
Middle Name:
Last Name:KELLEHER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 MAIN ST STE 203B
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01721-1187
Mailing Address - Country:US
Mailing Address - Phone:508-881-3029
Mailing Address - Fax:508-881-1752
Practice Address - Street 1:162 CORDAVILLE RD STE 185
Practice Address - Street 2:
Practice Address - City:SOUTHBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01772-1838
Practice Address - Country:US
Practice Address - Phone:508-281-9471
Practice Address - Fax:508-281-9130
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA205755363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Not Answered363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAC338OtherHARVARD PILGRIM
MANP3735OtherBLUE CROSS
MA0375811Medicaid
MA0375811Medicaid
MAC338OtherHARVARD PILGRIM