Provider Demographics
NPI:1033125356
Name:SHEA, LISA BRAFF (MD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:BRAFF
Last Name:SHEA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 BLACKSTONE BLVD
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-4800
Mailing Address - Country:US
Mailing Address - Phone:401-455-6200
Mailing Address - Fax:401-455-6309
Practice Address - Street 1:345 BLACKSTONE BLVD
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-4800
Practice Address - Country:US
Practice Address - Phone:401-455-6200
Practice Address - Fax:401-455-6309
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD082872084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
1093831646OtherBUTLER HOSPITAL PROFESSIONAL BILLING OFFICE
RI7003047Medicaid
RI25399-0OtherBLUE CROSS
RI15-30228OtherUNITED BEHAVIORAL HEALTH
RI400035OtherBLUE CHIP
RIP00402007OtherMEDICARE RAILROAD
RI1104801349OtherBUTLER HOSPITAL NPI
RI007006444Medicare ID - Type Unspecified
RI400035OtherBLUE CHIP