Provider Demographics
NPI:1114341906
Name:SHEA PEDIATRICS PC
Entity Type:Organization
Organization Name:SHEA PEDIATRICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN,FNP
Authorized Official - Prefix:MRS
Authorized Official - First Name:LOKESWARI
Authorized Official - Middle Name:
Authorized Official - Last Name:BUCCHIREDDIGARI
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:480-652-2931
Mailing Address - Street 1:8952 E DESERT COVE AVE
Mailing Address - Street 2:#110
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-6775
Mailing Address - Country:US
Mailing Address - Phone:480-767-3169
Mailing Address - Fax:
Practice Address - Street 1:8952 E DESERT COVE AVE
Practice Address - Street 2:#110
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-6775
Practice Address - Country:US
Practice Address - Phone:480-767-3169
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-13
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP5312364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily HealthGroup - Single Specialty