Provider Demographics
NPI:1508914623
Name:SWEENEY, DOLORITA ROSE (DO)
Entity Type:Individual
Prefix:DR
First Name:DOLORITA
Middle Name:ROSE
Last Name:SWEENEY
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 1:4666 W JEFFERSON BLVD
Mailing Address - Street 2:SUITE 144
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-6892
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:631-643-9839
Practice Address - Street 1:4666 W JEFFERSON BLVD
Practice Address - Street 2:SUITE 144
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-6892
Practice Address - Country:US
Practice Address - Phone:260-407-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1847712084P0800X, 2084P0804X
IN02004855A2084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY42M68Medicare UPIN