Provider Demographics
NPI:1184362535
Name:SHEA, LISA MARIE
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:SHEA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1370 COUNTY ROUTE 19
Mailing Address - Street 2:
Mailing Address - City:ELIZAVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12523-1203
Mailing Address - Country:US
Mailing Address - Phone:914-466-5776
Mailing Address - Fax:
Practice Address - Street 1:25 VAN WAGNER RD
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12603-1683
Practice Address - Country:US
Practice Address - Phone:845-462-6701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-25
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty