Provider Demographics
NPI:1467419234
Name:SHEA, JUDITH ORRILL (AUD)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:ORRILL
Last Name:SHEA
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:MISS
Other - First Name:JUDITH
Other - Middle Name:ANN
Other - Last Name:ORRILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:415 HIGHLAND AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:CHESHIRE
Mailing Address - State:CT
Mailing Address - Zip Code:06410-2563
Mailing Address - Country:US
Mailing Address - Phone:203-272-4512
Mailing Address - Fax:203-272-4517
Practice Address - Street 1:415 HIGHLAND AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:CHESHIRE
Practice Address - State:CT
Practice Address - Zip Code:06410-2563
Practice Address - Country:US
Practice Address - Phone:203-272-4512
Practice Address - Fax:203-272-4517
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2012-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000152231H00000X, 237600000X
CT000707235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTP2928474OtherOXFORD
CT660000707CT02OtherSPEECH PATHOLOGY
CT3272905OtherAETNA
CT730000152CT03OtherAUDIOLOGY
CT004236734Medicaid
CT0121288OtherCIGNA
CT2V6948OtherHEALTHNET
CT004070637Medicaid
CT152000OtherCONNECTICARE
CT0121288OtherCIGNA