Provider Demographics
NPI:1760464788
Name:SHEAHAN, TIMOTHY (DPM)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:SHEAHAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:446 E WATER STREET
Mailing Address - Street 2:
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14901-3411
Mailing Address - Country:US
Mailing Address - Phone:607-734-6006
Mailing Address - Fax:607-734-4036
Practice Address - Street 1:446 E WATER STREET
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14901-3411
Practice Address - Country:US
Practice Address - Phone:607-734-6006
Practice Address - Fax:607-734-4036
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-16
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN0029891213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00421352Medicaid
NY00421352Medicaid
NY51599BMedicare ID - Type Unspecified
NY1160200001Medicare NSC
NYJ300048138Medicare PIN