Provider Demographics
NPI:1710611199
Name:SHEA SPECIALTY SURGERY LLC
Entity Type:Organization
Organization Name:SHEA SPECIALTY SURGERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHANE
Authorized Official - Middle Name:
Authorized Official - Last Name:LIPSKIND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-389-6460
Mailing Address - Street 1:8426 E SHEA BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-6634
Mailing Address - Country:US
Mailing Address - Phone:480-860-4792
Mailing Address - Fax:
Practice Address - Street 1:8426 E SHEA BLVD STE 100
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-6634
Practice Address - Country:US
Practice Address - Phone:480-860-4792
Practice Address - Fax:480-860-6819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-12
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical