Healthcare Provider Details

I. General information

NPI: 1932023769
Provider Name (Legal Business Name): ROBERT SHEEHAN
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29500 SOUTHFIELD RD
SOUTHFIELD MI
48076-2030
US

IV. Provider business mailing address

31160 CLARK ST
NEW HAVEN MI
48048-1901
US

V. Phone/Fax

Practice location:
  • Phone: 248-765-1795
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6361008052
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: