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General NPI Number Information
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NPI Number | 1508030008
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Entity Type | Organization
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Legal Business Name | SHEAHAN EAGAN FAMILY CARE LLC
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Dates
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Enumeration Date | 04/15/2008
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Last Update Date | 04/15/2008
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Provider Practice Location Address
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Address Line | 16021 MANCHESTER RD
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City | ELLISVILLE
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State | MO
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Zip | 63011-2103
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Country | US
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Telephone | 314-458-6814
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Fax |
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Provider Business Mailing Address
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Address Line | 16021 MANCHESTER RD
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City | ELLISVILLE
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State | MO
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Zip | 63011-2103
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Country | US
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Telephone | 314-458-6814
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MELISSA R SHEAHAN
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Credential | D.C.
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Telephone | 314-458-6814
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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