MEDICARE: LISA ANN SHEA PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	010434	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	157484834	OTHER	NJ	DR. PATRICIA C MCCORMACK

General Provider Information

NPI Number	:	1336381136
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA ANN SHEA PA-C

Provider Business Mailing Address
First Line	:	1550 RICHMOND AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-1510
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1550 RICHMOND AVE
Second Line	:	SUITE 207
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-1578
Country	:	US
Telephone Number	:	718-698-1616
Fax Number	:	718-698-9573

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/25/2009
Last Update Date	:	04/23/2015

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Directions to “ LISA ANN SHEA PA-C” Practice Location

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