Provider Demographics
NPI:1033197686
Name:PAUL L SHEEHY JR DPM PA
Entity Type:Organization
Organization Name:PAUL L SHEEHY JR DPM PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:L
Authorized Official - Last Name:SHEEHY
Authorized Official - Suffix:JR
Authorized Official - Credentials:DPM
Authorized Official - Phone:813-872-8939
Mailing Address - Street 1:PO BOX 7756
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33673-7756
Mailing Address - Country:US
Mailing Address - Phone:813-872-8939
Mailing Address - Fax:813-872-8649
Practice Address - Street 1:812 W MLK JR BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33603-3338
Practice Address - Country:US
Practice Address - Phone:813-872-8939
Practice Address - Fax:813-872-8649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-04
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0827450001Medicare NSC