Provider Demographics
NPI:1972119790
Name:SHEA, SAMANTHA REGGI (MT)
Entity Type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:REGGI
Last Name:SHEA
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:619 HUFF ST STE 1
Mailing Address - Street 2:
Mailing Address - City:WINONA
Mailing Address - State:MN
Mailing Address - Zip Code:55987-3887
Mailing Address - Country:US
Mailing Address - Phone:507-454-7870
Mailing Address - Fax:507-454-7778
Practice Address - Street 1:619 HUFF ST STE 1
Practice Address - Street 2:
Practice Address - City:WINONA
Practice Address - State:MN
Practice Address - Zip Code:55987-3887
Practice Address - Country:US
Practice Address - Phone:507-454-7870
Practice Address - Fax:507-454-7778
Is Sole Proprietor?:No
Enumeration Date:2020-09-17
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist