Individual
MICHAEL DARRAN SHEA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
QMHA
Contact information
Practice address
109 NW MANZANITA AVE, GRANTS PASS, OR 97526
(541) 476-2373
Mailing address
1215 SW G ST, GRANTS PASS, OR 97526-2544
(541) 476-2373
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
175TOOOOOX
—
OR
Enumeration date
07/08/2021
Last updated
07/08/2021
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