Provider Demographics
NPI:1417212473
Name:SHEEHAN, JEFFREY (MS, LAC)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:SHEEHAN
Suffix:
Gender:M
Credentials:MS, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:539 W 144TH ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10031-5724
Mailing Address - Country:US
Mailing Address - Phone:917-447-4756
Mailing Address - Fax:
Practice Address - Street 1:80 8TH AVE
Practice Address - Street 2:SUITE 1304
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-5126
Practice Address - Country:US
Practice Address - Phone:917-447-4756
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-05
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004853171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist