Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0203X | Pediatric Critical Care Doctor | L5131 | TX |
NPI | 1154380475 |
---|---|
Provider Name | Maeve Sheehan |
First Address | Dallas, TX 75284-5347 |
Second Address | Dallas, TX 75390-7208 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2006 |
Last Update Date | 16/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G91791 | (02) |