Provider Demographics
NPI:1538714951
Name:SHEAHAN, COLLEEN NICOLE (AUD)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:NICOLE
Last Name:SHEAHAN
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:580 RITCHIE HWY STE I
Mailing Address - Street 2:
Mailing Address - City:SEVERNA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21146-3926
Mailing Address - Country:US
Mailing Address - Phone:410-647-7795
Mailing Address - Fax:410-315-8823
Practice Address - Street 1:600 RIDGELY AVE STE 110
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-1082
Practice Address - Country:US
Practice Address - Phone:410-263-8389
Practice Address - Fax:410-315-8823
Is Sole Proprietor?:No
Enumeration Date:2019-08-02
Last Update Date:2019-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01476231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist