Provider Demographics
NPI:1144407156
Name:SHEEHAN, JOHN T
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:T
Last Name:SHEEHAN
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 1:40 SNAKE MEADOW RD
Mailing Address - Street 2:
Mailing Address - City:DANIELSON
Mailing Address - State:CT
Mailing Address - Zip Code:06239-3828
Mailing Address - Country:US
Mailing Address - Phone:860-774-1029
Mailing Address - Fax:
Practice Address - Street 1:40 SNAKE MEADOW RD
Practice Address - Street 2:
Practice Address - City:DANIELSON
Practice Address - State:CT
Practice Address - Zip Code:06239-3828
Practice Address - Country:US
Practice Address - Phone:860-774-1029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-22
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT332B00000X332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT332B00000XOtherDURABLE MEDICAL EQUIPMENT