Provider Demographics
NPI:1801183702
Name:SHEA, CAITLIN (DO)
Entity Type:Individual
Prefix:DR
First Name:CAITLIN
Middle Name:
Last Name:SHEA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:532 LAFAYETTE RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SPARTA
Mailing Address - State:NJ
Mailing Address - Zip Code:07871-4411
Mailing Address - Country:US
Mailing Address - Phone:973-940-0423
Mailing Address - Fax:973-940-0399
Practice Address - Street 1:202 ROUTE 206 N
Practice Address - Street 2:SUITE A
Practice Address - City:SANDYSTON
Practice Address - State:NJ
Practice Address - Zip Code:07826-5082
Practice Address - Country:US
Practice Address - Phone:973-948-5577
Practice Address - Fax:973-948-0067
Is Sole Proprietor?:No
Enumeration Date:2011-06-30
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NJ25MB09391700207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ345126Medicare PIN