Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 175831 | NY |
NPI | 1194717108 |
---|---|
Provider Name | Michael Sheehan |
First Address | Syracuse, NY 13214-1849 |
Second Address | Syracuse, NY 13214-1849 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2005 |
Last Update Date | 21/03/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E57974 | (02) |