Provider Demographics
NPI:1710974530
Name:SHEA, JUDITH F (MD)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:F
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 1:7 RIVERSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06831-3627
Mailing Address - Country:US
Mailing Address - Phone:203-531-1808
Mailing Address - Fax:
Practice Address - Street 1:7 RIVERSVILLE RD
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06831-3627
Practice Address - Country:US
Practice Address - Phone:203-531-1808
Practice Address - Fax:203-531-8326
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT028512207R00000X
NY1763461207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
110001464Medicare ID - Type Unspecified
B39407Medicare UPIN