Provider Demographics
NPI:1801435524
Name:SHEA, VIRGINIA CARROLL
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:CARROLL
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 1:1044 ROSE CIR
Mailing Address - Street 2:
Mailing Address - City:PARK HILLS
Mailing Address - State:KY
Mailing Address - Zip Code:41011-1925
Mailing Address - Country:US
Mailing Address - Phone:859-802-4668
Mailing Address - Fax:
Practice Address - Street 1:1044 ROSE CIR
Practice Address - Street 2:
Practice Address - City:PARK HILLS
Practice Address - State:KY
Practice Address - Zip Code:41011-1925
Practice Address - Country:US
Practice Address - Phone:859-802-4668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-27
Last Update Date:2019-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator