Provider Demographics
NPI:1265504179
Name:SHEEHAN, THERESA CIARDI (MD FACP)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:CIARDI
Last Name:SHEEHAN
Suffix:
Gender:F
Credentials:MD FACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:647 OLD HOOVER RD
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27360-7452
Mailing Address - Country:US
Mailing Address - Phone:336-391-4382
Mailing Address - Fax:
Practice Address - Street 1:647 OLD HOOVER RD
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:NC
Practice Address - Zip Code:27360-7452
Practice Address - Country:US
Practice Address - Phone:336-391-4382
Practice Address - Fax:336-900-1426
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2002-00690208M00000X
NC200200690208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5900089Medicaid
NCG02973Medicare UPIN
NC5900089Medicaid