Provider Demographics
NPI:1740344266
Name:SHEA, DEIRDRE ANN (NP)
Entity type:Individual
Prefix:
First Name:DEIRDRE
Middle Name:ANN
Last Name:SHEA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 CAMBRIDGE ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-2743
Mailing Address - Country:US
Mailing Address - Phone:617-726-7797
Mailing Address - Fax:617-726-6950
Practice Address - Street 1:175 CAMBRIDGE ST
Practice Address - Street 2:SUITE 400
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2743
Practice Address - Country:US
Practice Address - Phone:617-726-7797
Practice Address - Fax:617-726-6950
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA216689363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0322491Medicaid
MANP4344Medicare ID - Type UnspecifiedMASS
MAQ03494Medicare UPIN