Provider Demographics
NPI:1902471899
Name:SHEERAN, KAYLA ALYSA (MED)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:ALYSA
Last Name:SHEERAN
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9720 PARK PLAZA AVE UNIT 102
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40241-2289
Mailing Address - Country:US
Mailing Address - Phone:502-396-1719
Mailing Address - Fax:
Practice Address - Street 1:9720 PARK PLAZA AVE UNIT 102
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-2289
Practice Address - Country:US
Practice Address - Phone:502-339-2442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-24
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY267617103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling