Provider Demographics
NPI:1376508630
Name:SHEA, PAUL F (MD)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:F
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 17987
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38187-0987
Mailing Address - Country:US
Mailing Address - Phone:901-761-9720
Mailing Address - Fax:901-683-8440
Practice Address - Street 1:6133 POPLAR PIKE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-4707
Practice Address - Country:US
Practice Address - Phone:901-761-9720
Practice Address - Fax:901-683-8440
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3873164Medicare ID - Type UnspecifiedMEDICARE IND NUMBER
TNH41279Medicare UPIN