Provider Demographics
NPI:1710174537
Name:SHEEDY, TRACEY (RPA-C)
Entity Type:Individual
Prefix:MRS
First Name:TRACEY
Middle Name:
Last Name:SHEEDY
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 OLD PARK LN
Mailing Address - Street 2:
Mailing Address - City:NEW MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06776-2560
Mailing Address - Country:US
Mailing Address - Phone:860-354-9321
Mailing Address - Fax:860-350-9304
Practice Address - Street 1:2 OLD PARK LN
Practice Address - Street 2:
Practice Address - City:NEW MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06776-2560
Practice Address - Country:US
Practice Address - Phone:860-354-9321
Practice Address - Fax:860-350-9304
Is Sole Proprietor?:No
Enumeration Date:2007-09-25
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001908363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical