Provider Demographics
NPI:1952447575
Name:SHEEHAN, MARCELLE L
Entity Type:Individual
Prefix:MS
First Name:MARCELLE
Middle Name:L
Last Name:SHEEHAN
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:MARCELLE
Other - Middle Name:L
Other - Last Name:SHEEHAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA,THSS, SLP
Mailing Address - Street 1:15 MORRIS LN
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11024-1706
Mailing Address - Country:US
Mailing Address - Phone:516-652-1283
Mailing Address - Fax:516-773-7931
Practice Address - Street 1:15 MORRIS LN
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11024-1706
Practice Address - Country:US
Practice Address - Phone:516-652-1283
Practice Address - Fax:516-773-7931
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009529235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY009529OtherSPEECH PATHOLOGIST