Amanda Marie Sheehan, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

2901020519 Issued in MI

Practice address

4626 W Walton Blvd
Waterford, MI 48329-3535

Phone

(248) 674-0384

Fax

(248) 674-1483

NPI assigned

Jun 5, 2011

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1307232000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1538524800000",
    "number": "1386938561",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4626 W WALTON BLVD",
            "city": "WATERFORD",
            "state": "MI",
            "postal_code": "483293535",
            "telephone_number": "248-674-0384",
            "fax_number": "248-674-1483"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4626 W WALTON BLVD",
            "city": "WATERFORD",
            "state": "MI",
            "postal_code": "483293535",
            "telephone_number": "248-674-0384",
            "fax_number": "248-674-1483"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHEEHAN",
        "first_name": "AMANDA",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-06-05",
        "last_updated": "2018-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MI",
            "license": "2901020519",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTIST",
            "identifier": "812398622",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Katherine Sharp, MA
• Kamee Elise Shatzer
• Arlene M Shearer, R.PH.
• C Sheehan
• Lauren Shelton
• Julie M Shereda
• Penny L Sherwood, RN, BSN
• Gordon Barry Shlom, DDS

• Dentist in Waterford, MI
• Providers in Waterford, MI by specialty
• Dentist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.