Provider Demographics
NPI:1093761850
Name:SHEA, STEVEN J (PHD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:J
Last Name:SHEA
Suffix:
Gender:M
Credentials:PHD
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Mailing Address - Street 1:5201 RAYMOND ST
Mailing Address - Street 2:ORLANDO VA MEDICAL CENTER, MENTAL HEALTH
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-8208
Mailing Address - Country:US
Mailing Address - Phone:321-397-6467
Mailing Address - Fax:407-599-1472
Practice Address - Street 1:5201 RAYMOND ST
Practice Address - Street 2:ORLANDO VA MEDICAL CENTER, MENTAL HEALTH
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-8208
Practice Address - Country:US
Practice Address - Phone:321-397-6467
Practice Address - Fax:407-599-1472
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC507103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical