Provider Demographics
NPI:1437356243
Name:JEFFREY SHEEDY DO LLC
Entity Type:Organization
Organization Name:JEFFREY SHEEDY DO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSCIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:M
Authorized Official - Last Name:SHEEDY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:574-935-9395
Mailing Address - Street 1:P O BOX 437
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:IN
Mailing Address - Zip Code:46563
Mailing Address - Country:US
Mailing Address - Phone:574-941-1040
Mailing Address - Fax:574-935-0080
Practice Address - Street 1:2855 MILLER DR
Practice Address - Street 2:SUITE 109
Practice Address - City:PLYMOUTH
Practice Address - State:IN
Practice Address - Zip Code:46563
Practice Address - Country:US
Practice Address - Phone:574-941-1040
Practice Address - Fax:574-935-0080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-27
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200384260Medicaid
IN200384260Medicaid