Healthcare Provider Details

I. General information

NPI: 1912949082
Provider Name (Legal Business Name): BRENDA SHEEHAN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 S STATE ST STE S2-500
SALT LAKE CITY UT
84190-0001
US

IV. Provider business mailing address

172 AMSTERDAM AVE
NEW YORK NY
10023-5034
US

V. Phone/Fax

Practice location:
  • Phone: 385-468-0555
  • Fax:
Mailing address:
  • Phone: 212-496-4600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number7861350-1204
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: