Provider Demographics
NPI:1255357083
Name:SHEA, PATRICIA A (MA,CCC-A)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:A
Last Name:SHEA
Suffix:
Gender:F
Credentials:MA,CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2920 MCINTYRE DR
Mailing Address - Street 2:SUITE 350
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47403-4221
Mailing Address - Country:US
Mailing Address - Phone:812-332-2226
Mailing Address - Fax:812-339-2934
Practice Address - Street 1:2920 MCINTYRE DR
Practice Address - Street 2:SUITE 350
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47403-4221
Practice Address - Country:US
Practice Address - Phone:812-332-2226
Practice Address - Fax:812-339-2934
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN23001968237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter