MEDICARE: EMILY A SHEAHAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	MD24610	OR

General Provider Information

NPI Number	:	1609821263
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY A SHEAHAN MD

Provider Business Mailing Address
First Line	:	616 W NORTH ST
Second Line	:
City	:	ENTERPRISE
State	:	OR
Zip	:	97828-1427
Country	:	US
Telephone Number	:	541-426-3797
Fax Number	:

Provider Business Practice Location Address
First Line	:	616 W NORTH ST
Second Line	:
City	:	ENTERPRISE
State	:	OR
Zip	:	97828-1427
Country	:	US
Telephone Number	:	541-426-3797
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2006
Last Update Date	:	07/08/2007

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