Basic Information
| Provider Information | |||||||||
| NPI: | 1255357083 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHEA | ||||||||
| FirstName: | PATRICIA | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | M.A.,CCC-A | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2920 MCINTYRE DR | ||||||||
| Address2: | SUITE 350 | ||||||||
| City: | BLOOMINGTON | ||||||||
| State: | IN | ||||||||
| PostalCode: | 474034221 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8123322226 | ||||||||
| FaxNumber: | 8123392934 | ||||||||
| Practice Location | |||||||||
| Address1: | 2920 MCINTYRE DR | ||||||||
| Address2: | SUITE 350 | ||||||||
| City: | BLOOMINGTON | ||||||||
| State: | IN | ||||||||
| PostalCode: | 474034221 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8123322226 | ||||||||
| FaxNumber: | 8123392934 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237600000X | 23001968 | IN | Y | Speech, Language and Hearing Service Providers | Audiologist-Hearing Aid Fitter |
No ID Information.