Provider Demographics
NPI:1619226818
Name:MCINTOSH, SHEEHAN RYAN
Entity Type:Individual
Prefix:MRS
First Name:SHEEHAN
Middle Name:RYAN
Last Name:MCINTOSH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4569 RELIANT RD
Mailing Address - Street 2:
Mailing Address - City:JAMESVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13078-8511
Mailing Address - Country:US
Mailing Address - Phone:315-657-5533
Mailing Address - Fax:
Practice Address - Street 1:4569 RELIANT RD
Practice Address - Street 2:
Practice Address - City:JAMESVILLE
Practice Address - State:NY
Practice Address - Zip Code:13078-8511
Practice Address - Country:US
Practice Address - Phone:315-657-5533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-04
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY638586163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse