Provider Demographics
NPI:1043684418
Name:SHEA, CASSIE
Entity type:Individual
Prefix:
First Name:CASSIE
Middle Name:
Last Name:SHEA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 S BLOUNT ST
Mailing Address - Street 2:APT 403
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27601-3102
Mailing Address - Country:US
Mailing Address - Phone:413-446-5173
Mailing Address - Fax:
Practice Address - Street 1:308 S BLOUNT ST
Practice Address - Street 2:APT 403
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27601-3102
Practice Address - Country:US
Practice Address - Phone:413-446-5173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-22
Last Update Date:2015-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-05823363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant