Provider Demographics
NPI:1407035413
Name:SHEEHAN, CRISTINA VIDAD (PT)
Entity Type:Individual
Prefix:MISS
First Name:CRISTINA
Middle Name:VIDAD
Last Name:SHEEHAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1579 STRAITS TPKE
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06762-1835
Mailing Address - Country:US
Mailing Address - Phone:203-577-2002
Mailing Address - Fax:203-577-2060
Practice Address - Street 1:51 SHERMAN HILL RD
Practice Address - Street 2:STE A201
Practice Address - City:WOODBURY
Practice Address - State:CT
Practice Address - Zip Code:06798-3694
Practice Address - Country:US
Practice Address - Phone:732-225-5454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-25
Last Update Date:2016-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01264000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist