Provider Demographics
NPI:1205188430
Name:SPEIGHTS, SHEA (ED D)
Entity Type:Individual
Prefix:DR
First Name:SHEA
Middle Name:
Last Name:SPEIGHTS
Suffix:
Gender:F
Credentials:ED D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1503 WARMAN CT
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-1527
Mailing Address - Country:US
Mailing Address - Phone:813-650-7720
Mailing Address - Fax:813-354-2534
Practice Address - Street 1:103 W HAMILTON AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33604-5420
Practice Address - Country:US
Practice Address - Phone:813-650-7720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-11
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL692610098Medicaid
FL692610096Medicaid