Provider Demographics
NPI:1912949082
Name:SHEEHAN, BRENDA (DO)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:SHEEHAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:172 AMSTERDAM AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-5034
Mailing Address - Country:US
Mailing Address - Phone:212-496-4600
Mailing Address - Fax:
Practice Address - Street 1:172 AMSTERDAM AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-5034
Practice Address - Country:US
Practice Address - Phone:212-496-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY224944207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5234C1Medicare ID - Type Unspecified
NYH96741Medicare UPIN