Provider Demographics
NPI:1720242456
Name:SHEEHAN, LORI A (MD)
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:A
Last Name:SHEEHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LORI
Other - Middle Name:A
Other - Last Name:SPECKHALS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:900 WALNUT ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-5509
Mailing Address - Country:US
Mailing Address - Phone:215-955-1234
Mailing Address - Fax:
Practice Address - Street 1:900 WALNUT ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-5509
Practice Address - Country:US
Practice Address - Phone:215-955-1234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-11
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4441522084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0311588Medicaid
PA102732855Medicaid
PA102732855Medicaid