Provider Demographics
NPI:1023251436
Name:SHEA, EILEEN (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:EILEEN
Middle Name:
Last Name:SHEA
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3514 UNIVERSITY DR STE 8
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-2659
Mailing Address - Country:US
Mailing Address - Phone:919-493-7002
Mailing Address - Fax:
Practice Address - Street 1:3500 REGENCY PKWY
Practice Address - Street 2:SUITE 120
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-8519
Practice Address - Country:US
Practice Address - Phone:919-465-3966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-15
Last Update Date:2009-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7652235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist