Provider Demographics
NPI:1346315991
Name:SHEA, CAROLINE JILL (MD)
Entity Type:Individual
Prefix:MS
First Name:CAROLINE
Middle Name:JILL
Last Name:SHEA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:842 S COWLEY STE 2
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202
Mailing Address - Country:US
Mailing Address - Phone:509-838-6686
Mailing Address - Fax:509-343-5115
Practice Address - Street 1:842 S COWLEY STE 2
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202
Practice Address - Country:US
Practice Address - Phone:509-838-6686
Practice Address - Fax:509-343-5115
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00042713207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0064600Medicaid
ID806548000Medicaid
WA8368599Medicaid
WA0173852OtherL&I
WAG40324Medicare UPIN