Provider Demographics
NPI:1053638551
Name:SHEA, SHANNON DENISE (MD)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:DENISE
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 1:120 KING ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32204-2410
Mailing Address - Country:US
Mailing Address - Phone:904-760-4940
Mailing Address - Fax:
Practice Address - Street 1:3900 UNIVERSITY BLVD S STE 2
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-4331
Practice Address - Country:US
Practice Address - Phone:904-760-4940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-23
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME130808208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARES000Medicare UPIN