Provider Demographics
NPI:1376818666
Name:SHEA, JOSHUA PETER (CRNA)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:PETER
Last Name:SHEA
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2310 N PATTERSON ST
Mailing Address - Street 2:BLDG C
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-2568
Mailing Address - Country:US
Mailing Address - Phone:229-244-6852
Mailing Address - Fax:229-242-2385
Practice Address - Street 1:2501 N PATTERSON ST
Practice Address - Street 2:SGMC
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-1735
Practice Address - Country:US
Practice Address - Phone:229-244-6852
Practice Address - Fax:229-242-2385
Is Sole Proprietor?:No
Enumeration Date:2012-03-20
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN190354367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered