1336260967 NPI number — JAMES K SHEA MD INC

Table of content: (NPI 1336260967)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336260967 NPI number — JAMES K SHEA MD INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JAMES K SHEA MD INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PHYSICAL MEDICINE PAIN CENTER PA
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336260967
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/11/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 547729
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORLANDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32854-7729
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:
407-843-5040

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1160 SANDY LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LONGWOOD
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32779-5825
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
321-279-5586
Provider Business Practice Location Address Fax Number:
407-843-5040
Provider Enumeration Date:
04/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SHEA
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
KEVIN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
407-422-0200

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  ME45929 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 204D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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