Individual
MARITA SHEEHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1400 S COULTER ST, AMARILLO, TX 79106-1786
(806) 354-5630
(806) 354-5689
Mailing address
1400 WALLACE BLVD, ATTN: CREDENTIALING, AMARILLO, TX 79106-1708
(806) 354-5585
(806) 356-4673
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
D9740
TX
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
D9740
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100218140 A
—
OK
05
—
138314309
—
TX
05
—
138314313
—
TX
05
—
E1575
—
NM
Enumeration date
07/07/2006
Last updated
12/30/2011
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