Healthcare Provider Details

I. General information

NPI: 1215264155
Provider Name (Legal Business Name): MICHAEL PAUL SHEEHAN RD, LDN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2009
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 BOND ST
SPRINGFIELD MA
01104-3401
US

IV. Provider business mailing address

25 BOND ST
SPRINGFIELD MA
01104-3401
US

V. Phone/Fax

Practice location:
  • Phone: 413-731-6043
  • Fax:
Mailing address:
  • Phone: 413-731-6043
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number2939
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: