Provider Demographics
NPI:1033160346
Name:SHEA, TIMOTHY JOHN (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:JOHN
Last Name:SHEA
Suffix:
Gender:M
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:PO BOX 602373
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-2373
Mailing Address - Country:US
Mailing Address - Phone:828-213-1500
Mailing Address - Fax:828-651-6570
Practice Address - Street 1:1409 ASHEVILLE HWY
Practice Address - Street 2:
Practice Address - City:BREVARD
Practice Address - State:NC
Practice Address - Zip Code:28712-9524
Practice Address - Country:US
Practice Address - Phone:828-435-8400
Practice Address - Fax:828-435-8401
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9800693207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNC6503COtherMEDICARE PTAN
NCNC6503DOtherMEDICARE PTAN
NC2254955BOtherMEDICARE PTAN
NCNC6503AOtherMEDICARE PTAN
NCNC6503BOtherMEDICARE PTAN
NCG69884Medicare UPIN
NC2254955Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID