Provider Demographics
NPI:1386644250
Name:SHEEHY, KERRY L (MD)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:L
Last Name:SHEEHY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1875 WOODWINDS DR
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-2298
Mailing Address - Country:US
Mailing Address - Phone:651-232-6700
Mailing Address - Fax:651-232-6711
Practice Address - Street 1:1875 WOODWINDS DR
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-2298
Practice Address - Country:US
Practice Address - Phone:651-232-6700
Practice Address - Fax:651-232-6711
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN34680207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN34680OtherMEDICAL LICENSE
MN34680OtherMEDICAL LICENSE