Provider Demographics
NPI:1922353267
Name:MATHEW, SHEELA (MS,FNP)
Entity Type:Individual
Prefix:MS
First Name:SHEELA
Middle Name:
Last Name:MATHEW
Suffix:
Gender:F
Credentials:MS,FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1055 PORTION RD
Mailing Address - Street 2:SUIT 11W
Mailing Address - City:FARMINGVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11738-2299
Mailing Address - Country:US
Mailing Address - Phone:631-736-4321
Mailing Address - Fax:
Practice Address - Street 1:1055 PORTION RD
Practice Address - Street 2:SUIT 11W
Practice Address - City:FARMINGVILLE
Practice Address - State:NY
Practice Address - Zip Code:11738-2299
Practice Address - Country:US
Practice Address - Phone:631-736-4321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-23
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF337416364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health