Provider Demographics
NPI:1578517926
Name:SHEA, HEIDI CHAMBERLAIN (MD)
Entity Type:Individual
Prefix:DR
First Name:HEIDI
Middle Name:CHAMBERLAIN
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:PO BOX 678118
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75267-8118
Mailing Address - Country:US
Mailing Address - Phone:214-363-5535
Mailing Address - Fax:214-368-2760
Practice Address - Street 1:1820 PRESTON PARK BLVD
Practice Address - Street 2:SUITE 1850
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-3656
Practice Address - Country:US
Practice Address - Phone:972-867-4658
Practice Address - Fax:972-867-8696
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK9417207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX7355710OtherAETNA
TX090003707Medicaid
TX7355710OtherAETNA