Provider Demographics
NPI:1376874768
Name:SHEEHAN, NIALL PATRICK (LAC)
Entity Type:Individual
Prefix:MR
First Name:NIALL
Middle Name:PATRICK
Last Name:SHEEHAN
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:928 NICHOLS DR
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-3506
Mailing Address - Country:US
Mailing Address - Phone:240-723-5513
Mailing Address - Fax:301-317-4704
Practice Address - Street 1:502 MAIN ST
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-4118
Practice Address - Country:US
Practice Address - Phone:240-723-5513
Practice Address - Fax:410-317-4704
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-25
Last Update Date:2010-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU01733171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist