Provider Demographics
NPI:1770691958
Name:SHEAHAN, KIRSTEN ERIKA (KIRSTEN)
Entity type:Individual
Prefix:MS
First Name:KIRSTEN
Middle Name:ERIKA
Last Name:SHEAHAN
Suffix:
Gender:F
Credentials:KIRSTEN
Other - Prefix:MS
Other - First Name:KIRSTEN
Other - Middle Name:ERIKA
Other - Last Name:RINDAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4300 UPLAND DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22310-1330
Mailing Address - Country:US
Mailing Address - Phone:703-402-6581
Mailing Address - Fax:
Practice Address - Street 1:110 IRVING ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010
Practice Address - Country:US
Practice Address - Phone:202-877-4848
Practice Address - Fax:202-877-2468
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2018-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD042290207P00000X
390200000X
NY250952207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY355595YGA4Medicaid