# SHEA ORTHOPEDIC AND SPORTS MEDICINE PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1225762917
- **Authorized official:** MICHAEL A SHEA MD (OWNER)
- **Authorized official phone:** (916) 984-4500

## Contact information

- **Practice address:** 1580 CREEKSIDE DRIVE, FOLSOM, CA 95630
- **Practice address phone:** (916) 984-4500
- **Practice address fax:** (915) 984-4502
- **Mailing address:** 1580 CREEKSIDE DRIVE, FOLSOM, CA 95630
- **Mailing address phone:** (916) 984-4500
- **Mailing address fax:** (915) 984-4502

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207QS0010X | Sports Medicine (Family Medicine) Physician | — | NULL | Yes |
| 207QS0010X | Sports Medicine (Family Medicine) Physician | — | — | Yes |
| 207XX0005X | Sports Medicine (Orthopaedic Surgery) Physician | — | NULL | — |
| 207XX0005X | Sports Medicine (Orthopaedic Surgery) Physician | — | — | — |

## Other

- **Enumeration date:** 07/11/2022
- **Last updated:** 07/13/2022