Healthcare Provider Details

I. General information

NPI: 1538714951
Provider Name (Legal Business Name): COLLEEN NICOLE SHEAHAN AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2019
Last Update Date: 08/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 RIDGELY AVE STE 110
ANNAPOLIS MD
21401-1082
US

IV. Provider business mailing address

580 RITCHIE HWY STE I
SEVERNA PARK MD
21146-3926
US

V. Phone/Fax

Practice location:
  • Phone: 410-263-8389
  • Fax: 410-315-8823
Mailing address:
  • Phone: 410-647-7795
  • Fax: 410-315-8823

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number01476
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: