Basic Information
| Provider Information | |||||||||
| NPI: | 1710174537 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHEEDY | ||||||||
| FirstName: | TRACEY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | R.P.A.-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2 OLD PARK LN | ||||||||
| Address2: | |||||||||
| City: | NEW MILFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 067762560 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8603549321 | ||||||||
| FaxNumber: | 8603509304 | ||||||||
| Practice Location | |||||||||
| Address1: | 2 OLD PARK LN | ||||||||
| Address2: | |||||||||
| City: | NEW MILFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 067762560 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8603549321 | ||||||||
| FaxNumber: | 8603509304 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/25/2007 | ||||||||
| LastUpdateDate: | 03/26/2013 | ||||||||
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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 | 363A00000X | 001908 | CT | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363AM0700X | 001908 | CT | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.