Provider Demographics
NPI:1346273224
Name:SHEEHAN, KELLY LYNNETTE (RD, CD-N)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:LYNNETTE
Last Name:SHEEHAN
Suffix:
Gender:F
Credentials:RD, CD-N
Other - Prefix:MS
Other - First Name:KELLY
Other - Middle Name:LYNNETTE
Other - Last Name:DEAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, CD-N
Mailing Address - Street 1:168 WHEELER RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:CT
Mailing Address - Zip Code:06468-2428
Mailing Address - Country:US
Mailing Address - Phone:203-452-8407
Mailing Address - Fax:
Practice Address - Street 1:130 DIVISION ST
Practice Address - Street 2:DINING SERVICES
Practice Address - City:DERBY
Practice Address - State:CT
Practice Address - Zip Code:06418-1326
Practice Address - Country:US
Practice Address - Phone:203-732-7585
Practice Address - Fax:203-732-7356
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000708133V00000X
911775133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered