Provider Demographics
NPI:1710318381
Name:SHEEHAN, ANGELA (NPP)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:SHEEHAN
Suffix:
Gender:F
Credentials:NPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:RENSSELAER
Mailing Address - State:NY
Mailing Address - Zip Code:12144-1437
Mailing Address - Country:US
Mailing Address - Phone:518-618-2263
Mailing Address - Fax:518-432-0440
Practice Address - Street 1:516 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:RENSSELAER
Practice Address - State:NY
Practice Address - Zip Code:12144
Practice Address - Country:US
Practice Address - Phone:518-618-2263
Practice Address - Fax:518-432-0440
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-09
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF401668363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health