Provider Demographics
NPI:1447269675
Name:SHEA, NICHOLAS HOWARD (MD)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:HOWARD
Last Name:SHEA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 111600
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34108-0127
Mailing Address - Country:US
Mailing Address - Phone:239-434-6410
Mailing Address - Fax:239-434-6410
Practice Address - Street 1:6400 DAVIS BLVD STE 104
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34104-5321
Practice Address - Country:US
Practice Address - Phone:239-403-2600
Practice Address - Fax:239-403-2602
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME25893207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL257877800Medicaid
FL257877800Medicaid
E49155Medicare UPIN