Basic Information
| Provider Information | |||||||||
| NPI: | 1093726515 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHEAHAN, III | ||||||||
| FirstName: | MALACHI | ||||||||
| MiddleName: | G. | ||||||||
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| NameSuffix: | III | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1340 POYDRAS ST | ||||||||
| Address2: | SUITE 1640 | ||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701121221 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5044121835 | ||||||||
| FaxNumber: | 5044121954 | ||||||||
| Practice Location | |||||||||
| Address1: | 1111 MEDICAL CENTER BLVD | ||||||||
| Address2: | SUITE N713 | ||||||||
| City: | MARRERO | ||||||||
| State: | LA | ||||||||
| PostalCode: | 700723151 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5043496713 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2006 | ||||||||
| LastUpdateDate: | 03/08/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0129X | 15751R | LA | N | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery | 2086S0129X | MD.15751R | LA | Y | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery |
ID Information
| ID | Type | State | Issuer | Description | 1468088 | 05 | LA | MEDICAID | 07776804 | 05 | MS | MEDICAID |