Provider Demographics
NPI:1588613004
Name:SHEA, VICKI
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:
Last Name:SHEA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18001 OLD CUTLER RD
Mailing Address - Street 2:SUITE 354
Mailing Address - City:VILLAGE OF PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-6416
Mailing Address - Country:US
Mailing Address - Phone:305-251-7477
Mailing Address - Fax:305-251-7475
Practice Address - Street 1:18001 OLD CUTLER RD
Practice Address - Street 2:SUITE 354
Practice Address - City:VILLAGE OF PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-6416
Practice Address - Country:US
Practice Address - Phone:305-251-7477
Practice Address - Fax:305-251-7475
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT11223225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist