Provider Demographics
NPI:1215264155
Name:SHEEHAN, MICHAEL PAUL (RD, LDN)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:PAUL
Last Name:SHEEHAN
Suffix:
Gender:M
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91 PROVIDENCE ST
Mailing Address - Street 2:APT 5
Mailing Address - City:CHICOPEE
Mailing Address - State:MA
Mailing Address - Zip Code:01020-1154
Mailing Address - Country:US
Mailing Address - Phone:413-537-8182
Mailing Address - Fax:
Practice Address - Street 1:91 PROVIDENCE ST
Practice Address - Street 2:APT 5
Practice Address - City:CHICOPEE
Practice Address - State:MA
Practice Address - Zip Code:01020-1154
Practice Address - Country:US
Practice Address - Phone:413-537-8182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-13
Last Update Date:2009-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2939133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered