Individual
SHEA KATHLEEN O'BRIEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
400 COLONNADE DR STE 230, PONTE VEDRA, FL 32081-6237
(904) 640-8249
(904) 640-8250
Mailing address
PO BOX 748817, ATLANTA, GA 30374-8817
(813) 286-0033
(813) 282-1806
Taxonomy
Speciality
Code
Description
License number
State
207VX0000X
Obstetrics Physician
Primary
ME151059
FL
390200000X
Student in an Organized Health Care Education/Training Program
TRN25522
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
TRN25522
—
FL
Enumeration date
06/29/2017
Last updated
06/23/2023
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