Healthcare Provider Details

I. General information

NPI: 1073805180
Provider Name (Legal Business Name): COLLEEN SHEEHAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2011
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2799 GATEWAY DR
RIVERSIDE CA
92507-0908
US

IV. Provider business mailing address

2799 GATEWAY DR
RIVERSIDE CA
92507-0908
US

V. Phone/Fax

Practice location:
  • Phone: 833-450-5967
  • Fax:
Mailing address:
  • Phone: 833-450-5967
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF305624
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number95000583
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: