Provider Demographics
NPI:1386938561
Name:SHEEHAN, AMANDA MARIE (DDS)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:MARIE
Last Name:SHEEHAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4626 W WALTON BLVD
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48329-3535
Mailing Address - Country:US
Mailing Address - Phone:248-674-0384
Mailing Address - Fax:248-674-1483
Practice Address - Street 1:4626 W WALTON BLVD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48329-3535
Practice Address - Country:US
Practice Address - Phone:248-674-0384
Practice Address - Fax:248-674-1483
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-05
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901020519122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI812398622OtherDENTIST