Provider Demographics
NPI:1487621157
Name:SHEDDAN, ANGELA J (ANP)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:J
Last Name:SHEDDAN
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8001 WINCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38125-2204
Mailing Address - Country:US
Mailing Address - Phone:901-262-6349
Mailing Address - Fax:901-339-3792
Practice Address - Street 1:215 E BOND AVE
Practice Address - Street 2:
Practice Address - City:WEST MEMPHIS
Practice Address - State:AR
Practice Address - Zip Code:72301-3550
Practice Address - Country:US
Practice Address - Phone:870-735-3842
Practice Address - Fax:870-732-1940
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2017-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA01872363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
57317Medicare ID - Type Unspecified