Provider Demographics
NPI:1164885489
Name:SHEEHAN, EAMONN (LATC)
Entity Type:Individual
Prefix:
First Name:EAMONN
Middle Name:
Last Name:SHEEHAN
Suffix:
Gender:M
Credentials:LATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 BOTOLPH ST
Mailing Address - Street 2:
Mailing Address - City:MELROSE
Mailing Address - State:MA
Mailing Address - Zip Code:02176-1147
Mailing Address - Country:US
Mailing Address - Phone:339-293-7244
Mailing Address - Fax:
Practice Address - Street 1:32 BOTOLPH ST
Practice Address - Street 2:
Practice Address - City:MELROSE
Practice Address - State:MA
Practice Address - Zip Code:02176-1147
Practice Address - Country:US
Practice Address - Phone:339-293-7244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-04
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11272255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer