Provider Demographics
NPI:1427454172
Name:SHEEHAN, HEIDI
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:SHEEHAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 JON J WAGNER WAY
Mailing Address - Street 2:
Mailing Address - City:LAGRANGEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12540-5062
Mailing Address - Country:US
Mailing Address - Phone:845-473-0459
Mailing Address - Fax:845-473-5994
Practice Address - Street 1:16 JON J WAGNER WAY
Practice Address - Street 2:
Practice Address - City:LAGRANGEVILLE
Practice Address - State:NY
Practice Address - Zip Code:12540-5062
Practice Address - Country:US
Practice Address - Phone:845-473-0459
Practice Address - Fax:845-473-5994
Is Sole Proprietor?:No
Enumeration Date:2014-11-07
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYI-055420183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist