Provider Demographics
NPI:1760489397
Name:SHEA, SEAN M (MD)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:M
Last Name:SHEA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1053 NE 95TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI SHORES
Mailing Address - State:FL
Mailing Address - Zip Code:33138-2547
Mailing Address - Country:US
Mailing Address - Phone:272-300-0063
Mailing Address - Fax:727-954-6546
Practice Address - Street 1:5200 NE 2ND AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33137-2706
Practice Address - Country:US
Practice Address - Phone:727-300-0063
Practice Address - Fax:727-954-6546
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2023-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME215542084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL400001240000OtherPREFERRED CARE PARTNERS
FL1007868OtherCARE PLUS
FL4069240OtherAETNA LIFE INS CO
FL059271400Medicaid
FL1256962OtherCIGNA
FL22358OtherWELLCARE/STAYWELL
FLD70704OtherVISTA
FL217614OtherAVMED
FL3099321OtherGHI
FL130018640OtherRAILROAD MEDICARE
FL3532MTSNOtherNHP
FL78416OtherBLUE CROSS BLUE SHIELD
FL1256962OtherCIGNA
FL400001240000OtherPREFERRED CARE PARTNERS