1811941545 NPI number — DANIELLE SHEA PT

Table of content: DANIELLE SHEA PT (NPI 1811941545)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811941545 NPI number — DANIELLE SHEA PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHEA
Provider First Name:
DANIELLE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1811941545
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/08/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2413 PROFESSIONAL DR
Provider Second Line Business Mailing Address:
PO BOX 7594
Provider Business Mailing Address City Name:
ROCKY MOUNT
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27804-2254
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
252-443-0808
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
721 TILGHMAN DR
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
DUNN
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28334-6063
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-892-5635
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  4583 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 067W3 . This is a "BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 2743631 . This is a "UHC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7275569 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7385878 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 195347 . This is a "MEDCOST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 198336 . This is a "MED RISK" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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