Provider Demographics
NPI:1124289178
Name:SHEERAN, IMELDA
Entity type:Individual
Prefix:
First Name:IMELDA
Middle Name:
Last Name:SHEERAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KEVIN
Other - Middle Name:
Other - Last Name:SHEERAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2001 E SABINE ST
Mailing Address - Street 2:STE 104
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-5644
Mailing Address - Country:US
Mailing Address - Phone:361-573-5600
Mailing Address - Fax:361-573-5601
Practice Address - Street 1:2001 E SABINE ST
Practice Address - Street 2:STE 104
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-5644
Practice Address - Country:US
Practice Address - Phone:361-573-5600
Practice Address - Fax:361-573-5601
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-23
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0104868332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX$$$$$$$$$OtherALL PRIVATE INSURANCES