Basic Information
| Provider Information | |||||||||
| NPI: | 1326592635 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GEOGHEGAN | ||||||||
| FirstName: | SHEENA | ||||||||
| MiddleName: | ELIZABETH | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 128 E, APPLE ST. SUITE 1820 | ||||||||
| Address2: | WSU DEPT. OF GERIATRICS | ||||||||
| City: | DAYTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 45409 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9372086359 | ||||||||
| FaxNumber: | 9372083096 | ||||||||
| Practice Location | |||||||||
| Address1: | 725 UNIVERISITY BLVD. | ||||||||
| Address2: | WRIGHT STATE PHYSICIANS | ||||||||
| City: | FAIRBORN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 45324 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9372457200 | ||||||||
| FaxNumber: | 9372457937 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2016 | ||||||||
| LastUpdateDate: | 08/04/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.