Healthcare Provider Details

I. General information

NPI: 1164410353
Provider Name (Legal Business Name): DEBORAH LOU SHEEHAN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DEBORAH LOU WINTER

II. Dates (important events)

Enumeration Date: 10/11/2005
Last Update Date: 07/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1202 E MAIN ST
WILLOW SPRINGS MO
65793-3588
US

IV. Provider business mailing address

1202 E MAIN ST
WILLOW SPRINGS MO
65793-3588
US

V. Phone/Fax

Practice location:
  • Phone: 417-469-1820
  • Fax: 417-469-5280
Mailing address:
  • Phone: 417-469-1820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number3619
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2009010253
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: