Provider Demographics
NPI:1043515786
Name:HICKEY, SHAUN
Entity Type:Individual
Prefix:MR
First Name:SHAUN
Middle Name:
Last Name:HICKEY
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 1:23 DIRT RD
Mailing Address - Street 2:
Mailing Address - City:MERRIMACK
Mailing Address - State:NH
Mailing Address - Zip Code:03054-4210
Mailing Address - Country:US
Mailing Address - Phone:603-459-5826
Mailing Address - Fax:603-457-2582
Practice Address - Street 1:23 DIRT RD
Practice Address - Street 2:
Practice Address - City:MERRIMACK
Practice Address - State:NH
Practice Address - Zip Code:03054-4210
Practice Address - Country:US
Practice Address - Phone:603-459-5826
Practice Address - Fax:603-457-2582
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-11
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications