Provider Demographics
NPI:1609948355
Name:O'SHEA, MARIA DA CONCEICAO (PT)
Entity type:Individual
Prefix:MS
First Name:MARIA
Middle Name:DA CONCEICAO
Last Name:O'SHEA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:MARIA
Other - Middle Name:DA CONCEICAO
Other - Last Name:O' SHEA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:215 PINEVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:BARDONIA
Mailing Address - State:NY
Mailing Address - Zip Code:10954
Mailing Address - Country:US
Mailing Address - Phone:845-624-0864
Mailing Address - Fax:845-357-3897
Practice Address - Street 1:2 EXECUTIVE BLVD
Practice Address - Street 2:STE 204A
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901
Practice Address - Country:US
Practice Address - Phone:845-357-5686
Practice Address - Fax:845-357-3897
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00525700225100000X
NY023818225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQN4081Medicare PIN
NJ080908Medicare ID - Type Unspecified