Individual
NICHOLAS JOSEPH SHEA
Active
Individual
NICHOLAS JOSEPH SHEA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
036123263
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036123263
—
IL
01
—
206147
MEDICARE PTAN (GROUP)
IL
01
—
206147027
MEDICARE PTAN (INDIVIDUAL)
IL
Enumeration date
08/22/2008
Last updated
04/09/2021
Update your record
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