Provider Demographics
NPI:1619475654
Name:SHEAHAN, KYLE SHEAHAN
Entity Type:Individual
Prefix:
First Name:KYLE SHEAHAN
Middle Name:
Last Name:SHEAHAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 PHILBRICK ST
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:NH
Mailing Address - Zip Code:03051-5323
Mailing Address - Country:US
Mailing Address - Phone:603-305-6440
Mailing Address - Fax:
Practice Address - Street 1:21 PHILBRICK ST
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:NH
Practice Address - Zip Code:03051-5323
Practice Address - Country:US
Practice Address - Phone:603-305-6440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-24
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer