Healthcare Provider Details

I. General information

NPI: 1043880073
Provider Name (Legal Business Name): GWENDOLYN J SHEEHY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2021
Last Update Date: 01/30/2023
Certification Date: 01/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

153 E N B BAROODY ST
FLORENCE SC
29506-2523
US

IV. Provider business mailing address

413 GRAHAM ST
FLORENCE SC
29501-4736
US

V. Phone/Fax

Practice location:
  • Phone: 843-662-7802
  • Fax:
Mailing address:
  • Phone: 513-886-2568
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: