Provider Demographics
NPI:1215150164
Name:SHEERAN, KEVIN D (CONTRACTOR)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:D
Last Name:SHEERAN
Suffix:
Gender:M
Credentials:CONTRACTOR
Other - Prefix:MRS
Other - First Name:IMELDA
Other - Middle Name:R
Other - Last Name:SHEERAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1502 E RED RIVER ST # 131
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-5523
Mailing Address - Country:US
Mailing Address - Phone:361-935-0514
Mailing Address - Fax:361-573-7713
Practice Address - Street 1:1502 E RED RIVER ST # 131
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-5523
Practice Address - Country:US
Practice Address - Phone:361-935-0514
Practice Address - Fax:361-573-7713
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19890171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications