Active NPI
Samantha Marie Sheeran, LP
- Clinical Psychologist
- Mora, MN
National Provider Identifier
1639683097
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- LP6094
- Practice address
- 2031 Rowland Rd
Mora, MN 55051-7119 - Phone
- (844) 314-4673
- NPI assigned
- Nov 21, 2017
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | LP6094 | MN | Primary |
Addresses
Primary practice location
2031 Rowland Rd
Mora, MN 55051-7119
Mailing address
38053 Harvester Ave
North Branch, MN 55056-6125
Phone (773) 419-7941
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LP6094 | MN | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1511222400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1511222400000",
"number": "1639683097",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "38053 HARVESTER AVE",
"city": "NORTH BRANCH",
"state": "MN",
"postal_code": "550566125",
"telephone_number": "773-419-7941"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2031 ROWLAND RD",
"city": "MORA",
"state": "MN",
"postal_code": "550517119",
"telephone_number": "844-314-4673"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHEERAN",
"first_name": "SAMANTHA",
"middle_name": "MARIE",
"name_prefix": "Dr.",
"credential": "LP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-11-21",
"last_updated": "2017-11-21",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MN",
"license": "LP6094",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mora, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.