Provider Demographics
NPI:1982689634
Name:SHEA, ALEXANDRA (CNM)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:SHEA
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 FRANCIS ST
Mailing Address - Street 2:CWN 5
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-6110
Mailing Address - Country:US
Mailing Address - Phone:617-732-5053
Mailing Address - Fax:617-975-0987
Practice Address - Street 1:75 FRANCIS ST
Practice Address - Street 2:CWN 5
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-6110
Practice Address - Country:US
Practice Address - Phone:617-732-5053
Practice Address - Fax:617-975-0987
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA200342367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife