1427272517 NPI number — MRS. AMY PATRICE SHEA OTR

Table of content: MRS. AMY PATRICE SHEA OTR (NPI 1427272517)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427272517 NPI number — MRS. AMY PATRICE SHEA OTR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHEA
Provider First Name:
AMY
Provider Middle Name:
PATRICE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
OTR
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427272517
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/13/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
31467 SMITHSON VALLEY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BULVERDE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78163
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
830-438-3783
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2395 BULVERDE RD
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
BULVERDE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78163-4571
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
830-980-6880
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , with the licence number:  110020 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 8T4330 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8T3179 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com