Provider Demographics
NPI:1205531423
Name:MEAD, SHEENA
Entity type:Individual
Prefix:
First Name:SHEENA
Middle Name:
Last Name:MEAD
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 WOODSTONE RD
Mailing Address - Street 2:
Mailing Address - City:NORTHBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01532-1050
Mailing Address - Country:US
Mailing Address - Phone:508-439-0730
Mailing Address - Fax:
Practice Address - Street 1:169 S RIVER RD UNIT 7
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110-6934
Practice Address - Country:US
Practice Address - Phone:603-232-5490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-05
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NH051961223G0001X
MEDEN50671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program