Provider Demographics
NPI:1790149086
Name:SHEA, NICHOLAS JOHN (MD, MS)
Entity Type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:JOHN
Last Name:SHEA
Suffix:
Gender:M
Credentials:MD, MS
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Other - Credentials:
Mailing Address - Street 1:PO BOX 416457
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-6457
Mailing Address - Country:US
Mailing Address - Phone:844-362-1735
Mailing Address - Fax:973-290-7495
Practice Address - Street 1:100 MADISON AVE
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-6136
Practice Address - Country:US
Practice Address - Phone:973-971-7300
Practice Address - Fax:973-984-7019
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-12
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY295509208600000X
NJ25MA11509800208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No208600000XAllopathic & Osteopathic PhysiciansSurgery