Provider Demographics
NPI:1639511520
Name:O'SHEA, MARY CATHLEEN
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:CATHLEEN
Last Name:O'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 1:4685 FOREST AVE STE C
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45212-3359
Mailing Address - Country:US
Mailing Address - Phone:513-246-7796
Mailing Address - Fax:513-852-8525
Practice Address - Street 1:8040 PRINCETON-GLENDALE RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45069-0000
Practice Address - Country:US
Practice Address - Phone:513-246-7000
Practice Address - Fax:513-246-5479
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-22
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA14677363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH87943Medicaid
OHCOA.14677OtherOHIO LICENSE
OHH227381Medicare PIN