Provider Demographics
NPI:1164761011
Name:SHEEHAN, COLETTE M (MSED)
Entity Type:Individual
Prefix:MRS
First Name:COLETTE
Middle Name:M
Last Name:SHEEHAN
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4720 42ND STREET
Mailing Address - Street 2:APT. 6H
Mailing Address - City:SUNNYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11104-3048
Mailing Address - Country:US
Mailing Address - Phone:347-204-7208
Mailing Address - Fax:
Practice Address - Street 1:4720 42ND STREET
Practice Address - Street 2:APT. 6H
Practice Address - City:SUNNYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11104-3048
Practice Address - Country:US
Practice Address - Phone:347-204-7208
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-12
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY677825121103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst