Healthcare Provider Details

I. General information

NPI: 1548311095
Provider Name (Legal Business Name): PAMELA ANN SHEEAN OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

543 HEGGE DR
SIERRA VISTA AZ
85635-1110
US

IV. Provider business mailing address

543 HEGGE DR
SIERRA VISTA AZ
85635-1110
US

V. Phone/Fax

Practice location:
  • Phone: 520-515-0648
  • Fax:
Mailing address:
  • Phone: 520-515-0648
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175L00000X
TaxonomyHomeopath
License Number1174
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: