MEDICARE: SHEAMAN INC.

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)	LP2029	MN

General Provider Information

NPI Number	:	1760723563
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHEAMAN INC.

Provider Business Mailing Address
First Line	:	1730 CLIFTON PL
Second Line	:	SUITE 111
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55403-3242
Country	:	US
Telephone Number	:	612-871-2165
Fax Number	:	612-871-2448

Provider Business Practice Location Address
First Line	:	1730 CLIFTON PL
Second Line	:	SUITE 111
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55403-3242
Country	:	US
Telephone Number	:	612-871-2165
Fax Number	:	612-871-2448

Authorized Official
Title or Position	:	LICENSE PYSCHOLOGIST, OWNER
Name	:	DR. MICHAEL J. SHEA
Credential	:	PH.D.
Telephone Number	:	612-871-2165

Provider Enumeration Date	:	03/05/2013
Last Update Date	:	03/05/2013

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