Provider Demographics
NPI:1225285364
Name:SHEERAN, KELLY (ME/SLP)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:SHEERAN
Suffix:
Gender:F
Credentials:ME/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 THATCHER WAY
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-1233
Mailing Address - Country:US
Mailing Address - Phone:919-870-9591
Mailing Address - Fax:919-846-4705
Practice Address - Street 1:805 THATCHER WAY
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-1233
Practice Address - Country:US
Practice Address - Phone:919-870-9591
Practice Address - Fax:919-846-4705
Is Sole Proprietor?:No
Enumeration Date:2008-08-20
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist