Healthcare Provider Details

I. General information

NPI: 1356737100
Provider Name (Legal Business Name): MICHELLE DIANE SHEAHAN MSW, LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2015
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4545 42ND ST NW STE 200
WASHINGTON DC
20016-4623
US

IV. Provider business mailing address

4545 42ND ST NW STE 200
WASHINGTON DC
20016-4623
US

V. Phone/Fax

Practice location:
  • Phone: 202-413-4431
  • Fax:
Mailing address:
  • Phone: 202-413-4431
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP500009459
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC50080431
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: