Provider Demographics
NPI:1033396809
Name:SHEEDY, PAUL CROWLEY
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:CROWLEY
Last Name:SHEEDY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7518 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:RED HOOK
Mailing Address - State:NY
Mailing Address - Zip Code:12571-1400
Mailing Address - Country:US
Mailing Address - Phone:845-758-9612
Mailing Address - Fax:
Practice Address - Street 1:7518 N BROADWAY
Practice Address - Street 2:
Practice Address - City:RED HOOK
Practice Address - State:NY
Practice Address - Zip Code:12571-1400
Practice Address - Country:US
Practice Address - Phone:845-758-9612
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-23
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050452-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist