Provider Demographics
NPI:1609229004
Name:SHEA, JULIANA
Entity Type:Individual
Prefix:
First Name:JULIANA
Middle Name:
Last Name:SHEA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JULIANA
Other - Middle Name:DA COSTA
Other - Last Name:PEREIRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:37 WINSEGANSETT AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRHAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02719-1117
Mailing Address - Country:US
Mailing Address - Phone:774-929-0880
Mailing Address - Fax:
Practice Address - Street 1:3119 CRANBERRY HWY
Practice Address - Street 2:
Practice Address - City:EAST WAREHAM
Practice Address - State:MA
Practice Address - Zip Code:02538-4840
Practice Address - Country:US
Practice Address - Phone:508-759-5411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-20
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA22307225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist