Basic Information
| Provider Information | |||||||||
| NPI: | 1295726073 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | O'SHEA | ||||||||
| FirstName: | SHERYL | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3338 | ||||||||
| Address2: | |||||||||
| City: | TOHAJIILEE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 870263338 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5059082307 | ||||||||
| FaxNumber: | 5059082310 | ||||||||
| Practice Location | |||||||||
| Address1: | 129 MEDICINE HORSE DRIVE | ||||||||
| Address2: | |||||||||
| City: | TO'HAJIILEE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 87026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5059082307 | ||||||||
| FaxNumber: | 5059082310 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/02/2005 | ||||||||
| LastUpdateDate: | 06/15/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/15/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 2000-256 | NM | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.