Provider Demographics
NPI:1942314505
Name:CONNERNEY, SHEILA DWYER (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:DWYER
Last Name:CONNERNEY
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:SHEILA
Other - Middle Name:ELLEN
Other - Last Name:DWYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NURSE PRACTITIONER
Mailing Address - Street 1:1250 HANCOCK ST STE 502S
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-4339
Mailing Address - Country:US
Mailing Address - Phone:617-421-2686
Mailing Address - Fax:617-774-0606
Practice Address - Street 1:1250 HANCOCK ST STE 502S
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-4339
Practice Address - Country:US
Practice Address - Phone:617-421-2686
Practice Address - Fax:617-774-0606
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA258690363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner