Healthcare Provider Details

I. General information

NPI: 1144407156
Provider Name (Legal Business Name): JOHN T SHEEHAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2008
Last Update Date: 01/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 SNAKE MEADOW RD
DANIELSON CT
06239-3828
US

IV. Provider business mailing address

40 SNAKE MEADOW RD
DANIELSON CT
06239-3828
US

V. Phone/Fax

Practice location:
  • Phone: 860-774-1029
  • Fax:
Mailing address:
  • Phone: 860-774-1029
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number332B00000X
License Number StateCT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier332B00000X
Identifier TypeOTHER
Identifier StateCT
Identifier IssuerDURABLE MEDICAL EQUIPMENT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: