Provider Demographics
NPI:1083864888
Name:SHEA, MARCIE (MD)
Entity Type:Individual
Prefix:
First Name:MARCIE
Middle Name:
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:PO BOX 1999
Mailing Address - Street 2:
Mailing Address - City:LEE'S SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64063
Mailing Address - Country:US
Mailing Address - Phone:816-287-0258
Mailing Address - Fax:816-408-3330
Practice Address - Street 1:DR. MARCIE SHEA C/O WESTERN MISSOURI MEDICAL CENTER BRI
Practice Address - Street 2:403 BURKARTH RD
Practice Address - City:WARRENSBURG
Practice Address - State:MO
Practice Address - Zip Code:64093
Practice Address - Country:US
Practice Address - Phone:816-287-0258
Practice Address - Fax:816-408-3330
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-29
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20100226382084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO209533504Medicaid