Provider Demographics
NPI:1336260967
Name:JAMES K SHEA MD INC
Entity Type:Organization
Organization Name:JAMES K SHEA MD INC
Other - Org Name:PHYSICAL MEDICINE PAIN CENTER PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:KEVIN
Authorized Official - Last Name:SHEA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-422-0200
Mailing Address - Street 1:PO BOX 547729
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32854-7729
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:407-843-5040
Practice Address - Street 1:1160 SANDY LN
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32779-5825
Practice Address - Country:US
Practice Address - Phone:321-279-5586
Practice Address - Fax:407-843-5040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME45929174400000X
204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK1451Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER