Provider Demographics
NPI:1528360526
Name:SHEAHAN, CATHERINE (PMHNP)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:SHEAHAN
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 WALNUT ST # 16292
Mailing Address - Street 2:
Mailing Address - City:GREEN COVE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32043-3443
Mailing Address - Country:US
Mailing Address - Phone:518-934-2080
Mailing Address - Fax:555-000-0000
Practice Address - Street 1:411 WALNUT ST # 16292
Practice Address - Street 2:
Practice Address - City:GREEN COVE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32043-3443
Practice Address - Country:US
Practice Address - Phone:518-934-2080
Practice Address - Fax:555-000-0000
Is Sole Proprietor?:No
Enumeration Date:2010-11-23
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11004815363LP0808X
CT004546363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAPRN11004815OtherSTATE LICENSE
CT008057606Medicaid
CT004236130Medicaid
CTD100215586Medicare UPIN