Provider Demographics
NPI:1780634535
Name:SHEEHAN, SANDRA R (DPM)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:R
Last Name:SHEEHAN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1738 METROMEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-3861
Mailing Address - Country:US
Mailing Address - Phone:910-484-4191
Mailing Address - Fax:910-484-5546
Practice Address - Street 1:1738 METROMEDICAL DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3861
Practice Address - Country:US
Practice Address - Phone:910-484-4191
Practice Address - Fax:910-484-5546
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC214213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0810GOtherBCBS
NC890810GMedicaid
NC243138AMedicare ID - Type Unspecified
NC890810GMedicaid