MEDICARE: SANDRA RENEE SHEAHON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	PTA32457	FL

General Provider Information

NPI Number	:	1841902624
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA RENEE SHEAHON

Provider Business Mailing Address
First Line	:	1208 ATHENS CT
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32305-3202
Country	:	US
Telephone Number	:	419-324-4196
Fax Number	:

Provider Business Practice Location Address
First Line	:	2255 CENTERVILLE RD
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32308-4315
Country	:	US
Telephone Number	:	850-386-4054
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/23/2022
Last Update Date	:	12/23/2022

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Directions to “ SANDRA RENEE SHEAHON ” Practice Location

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