Provider Demographics
NPI:1578537924
Name:SHEEHAN, JOSEPH M (ATC, CSCS)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:M
Last Name:SHEEHAN
Suffix:
Gender:M
Credentials:ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5513 LONDON LAKE DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32258-5381
Mailing Address - Country:US
Mailing Address - Phone:904-288-6615
Mailing Address - Fax:
Practice Address - Street 1:1 ALLTEL STADIUM PL
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32202-1918
Practice Address - Country:US
Practice Address - Phone:904-633-2250
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL11112255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer