Provider Demographics
NPI:1124380308
Name:O'SHEA, JAMES ALEXANDER (TEACHER)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:ALEXANDER
Last Name:O'SHEA
Suffix:
Gender:M
Credentials:TEACHER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 HILLTOP DR
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-2015
Mailing Address - Country:US
Mailing Address - Phone:631-645-3538
Mailing Address - Fax:
Practice Address - Street 1:26 HILLTOP DR
Practice Address - Street 2:
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-2015
Practice Address - Country:US
Practice Address - Phone:631-645-3538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-13
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY891809174400000X
NYF405095-1363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No174400000XOther Service ProvidersSpecialist