Provider Demographics
NPI:1144565094
Name:SHEA, TIMOTHY P, (PSYD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:P,
Last Name:SHEA
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 S BROADWAY STE 200-301
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80209-1558
Mailing Address - Country:US
Mailing Address - Phone:720-579-2226
Mailing Address - Fax:970-360-1531
Practice Address - Street 1:1732 YOSEMITE ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-5404
Practice Address - Country:US
Practice Address - Phone:908-268-1274
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-04
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPSY.0004653103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist