Provider Demographics
NPI:1033370564
Name:SHEEHY, COLLEEN MELISSA (CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:COLLEEN
Middle Name:MELISSA
Last Name:SHEEHY
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 AVE AT PORT IMPERIAL
Mailing Address - Street 2:931
Mailing Address - City:WEST NEW YORK
Mailing Address - State:NJ
Mailing Address - Zip Code:07093-7101
Mailing Address - Country:US
Mailing Address - Phone:203-394-3049
Mailing Address - Fax:
Practice Address - Street 1:20 HOSPITAL SERVICE ROAD SOUTH
Practice Address - Street 2:
Practice Address - City:VALHALLA
Practice Address - State:NY
Practice Address - Zip Code:10595
Practice Address - Country:US
Practice Address - Phone:914-493-8150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-18
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024413235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist