Provider Demographics
NPI:1588344121
Name:NAKADA, SHEAMUS MICHAEL (MILITARY PROVIDER)
Entity type:Individual
Prefix:
First Name:SHEAMUS
Middle Name:MICHAEL
Last Name:NAKADA
Suffix:
Gender:M
Credentials:MILITARY PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 SAVANNAH DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-8673
Mailing Address - Country:US
Mailing Address - Phone:630-329-5556
Mailing Address - Fax:
Practice Address - Street 1:1ST MARINE RAIDER BATTALION AID STATION
Practice Address - Street 2:
Practice Address - City:SNEADS FERRY
Practice Address - State:NC
Practice Address - Zip Code:28460
Practice Address - Country:US
Practice Address - Phone:910-440-2499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-19
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC05225409SN1710I1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman