Provider Demographics
NPI:1053308924
Name:SHEEHY JR, PAUL L (DPM)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:L
Last Name:SHEEHY JR
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:PAUL
Other - Middle Name:L
Other - Last Name:SHEEHY JR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM
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
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLP00002216213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL056645400Medicaid
FL056645400Medicaid
T92640Medicare UPIN