Healthcare Provider Details

I. General information

NPI: 1720069719
Provider Name (Legal Business Name): ELIZABETH H SHEERAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/08/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BOSTON MEDICAL CTR PL DOWLING 3 SOUTH CHILD HEALTH FOUNDATION OF BOSTON
BOSTON MA
02118-2908
US

IV. Provider business mailing address

1 BOSTON MEDICAL CTR PL DOWLING 3 SOUTH DIVISION OF PEDIATRICS
BOSTON MA
02118-2908
US

V. Phone/Fax

Practice location:
  • Phone: 617-414-5170
  • Fax: 617-414-3803
Mailing address:
  • Phone: 617-414-5170
  • Fax: 617-414-3803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number209404
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number209404
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: