Provider Demographics
NPI:1417900754
Name:SHEEHAN, MELISSA G (DO)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:G
Last Name:SHEEHAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 SILVERSIDE RD
Mailing Address - Street 2:SUITE 111
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19809-1774
Mailing Address - Country:US
Mailing Address - Phone:302-798-0666
Mailing Address - Fax:302-798-4905
Practice Address - Street 1:405 SILVERSIDE RD
Practice Address - Street 2:SUITE 111
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19809-1774
Practice Address - Country:US
Practice Address - Phone:302-798-0666
Practice Address - Fax:302-798-4905
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC2-0007387207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE100003508Medicaid
021573T76Medicare PIN
DE100003508Medicaid