Provider Demographics
NPI:1649237736
Name:SHEEHAN, REBECCA ROSE (PNP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:ROSE
Last Name:SHEEHAN
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:YALMOKAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6 WELLNESS WAY STE 201
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-2156
Mailing Address - Country:US
Mailing Address - Phone:518-782-3700
Mailing Address - Fax:518-782-3799
Practice Address - Street 1:6 WELLNESS WAY STE 101
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-2156
Practice Address - Country:US
Practice Address - Phone:518-782-7733
Practice Address - Fax:518-782-0800
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRTNPP37259363L00000X
NY381906363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03017347Medicaid
509003864Medicare ID - Type Unspecified
RIRS55737Medicaid