Provider Demographics
NPI:1295030369
Name:SHEEHAN, DIANE M (APRN)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:M
Last Name:SHEEHAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 MILL HILL AVE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06610-2826
Mailing Address - Country:US
Mailing Address - Phone:203-373-7388
Mailing Address - Fax:
Practice Address - Street 1:5520 PARK AVE
Practice Address - Street 2:STE. 306
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-3463
Practice Address - Country:US
Practice Address - Phone:203-373-7388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-20
Last Update Date:2014-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT4560363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily