Provider Demographics
NPI:1023218799
Name:SHEA, LEO J III (PHD)
Entity Type:Individual
Prefix:DR
First Name:LEO
Middle Name:J
Last Name:SHEA
Suffix:III
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:151 E 31ST ST
Mailing Address - Street 2:#22C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-9500
Mailing Address - Country:US
Mailing Address - Phone:212-951-4545
Mailing Address - Fax:212-842-0731
Practice Address - Street 1:201 E 28TH ST
Practice Address - Street 2:#1D
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-8538
Practice Address - Country:US
Practice Address - Phone:212-951-4545
Practice Address - Fax:212-842-0731
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-20
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY0136581103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist