Provider Demographics
NPI:1023463783
Name:SHEEHAN, KELLY (RN, IBCLC)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:SHEEHAN
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 EISENHOWER RD
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062-3648
Mailing Address - Country:US
Mailing Address - Phone:617-778-8654
Mailing Address - Fax:
Practice Address - Street 1:24 EISENHOWER RD
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-3648
Practice Address - Country:US
Practice Address - Phone:617-778-8654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-02
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA264681163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant