Basic Information
Provider Information
NPI: 1174183263
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: O'SHEA
FirstName: LINDSEY
MiddleName:  
NamePrefix: MRS.
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3601 S 6TH AVE BLDG 60
Address2:  
City: TUCSON
State: AZ
PostalCode: 857230001
CountryCode: US
TelephoneNumber: 5207921450
FaxNumber:  
Practice Location
Address1: 3601 S 6TH AVE
Address2:  
City: TUCSON
State: AZ
PostalCode: 857230001
CountryCode: US
TelephoneNumber: 5207921450
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/19/2019
LastUpdateDate: 11/10/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
235Z00000XSLP11291AZY Speech, Language and Hearing Service ProvidersSpeech-Language Pathologist 

No ID Information.


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