Provider Demographics
NPI:1235424136
Name:O'SHEA, JIAJIA (DO)
Entity Type:Individual
Prefix:DR
First Name:JIAJIA
Middle Name:
Last Name:O'SHEA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:JIAJIA
Other - Middle Name:
Other - Last Name:GAO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:55 BAYBERRY LN
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29572-5600
Mailing Address - Country:US
Mailing Address - Phone:978-621-2457
Mailing Address - Fax:
Practice Address - Street 1:55 BAYBERRY LN
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29572-5600
Practice Address - Country:US
Practice Address - Phone:978-621-2457
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-20
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT01397390200000X
SCDO37602207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program