Healthcare Provider Details

I. General information

NPI: 1316041734
Provider Name (Legal Business Name): JAMES M. SHEHAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12910 PIERCE ST STE 120
OMAHA NE
68144-1106
US

IV. Provider business mailing address

12910 PIERCE ST STE 120
OMAHA NE
68144-1106
US

V. Phone/Fax

Practice location:
  • Phone: 402-933-3770
  • Fax: 402-916-4662
Mailing address:
  • Phone: 402-933-3770
  • Fax: 402-916-4662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number22767
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: