Provider Demographics
NPI:1023048667
Name:SHEEHY, EILEEN P (MD)
Entity type:Individual
Prefix:
First Name:EILEEN
Middle Name:P
Last Name:SHEEHY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:164 EAST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743
Mailing Address - Country:US
Mailing Address - Phone:631-427-0530
Mailing Address - Fax:631-427-0147
Practice Address - Street 1:164 EAST MAIN STREET
Practice Address - Street 2:HUNTINGTON PEDIATRICS PC
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743
Practice Address - Country:US
Practice Address - Phone:631-427-0530
Practice Address - Fax:631-427-0530
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY146585208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
520Y71OtherBCBS
146585OtherHIP
756OtherVYTRA
NY00716252Medicaid
NY00716252Medicaid