Provider Demographics
NPI:1144385287
Name:SHEA, JAMES K (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:K
Last Name:SHEA
Suffix:
Gender:M
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 547729
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32854-7729
Mailing Address - Country:US
Mailing Address - Phone:321-279-5586
Mailing Address - Fax:407-843-5040
Practice Address - Street 1:16890 US HIGHWAY 441
Practice Address - Street 2:
Practice Address - City:MOUNT DORA
Practice Address - State:FL
Practice Address - Zip Code:32757-6705
Practice Address - Country:US
Practice Address - Phone:352-385-4404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME45929208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME45929OtherFLORIDA MEDICAL LICENSE
FLME45929OtherFLORIDA MEDICAL LICENSE
TXG2574OtherTEXAS MEDICAL LICENSE
FL15953XMedicare ID - Type UnspecifiedMEDICARE