Healthcare Provider Details

I. General information

NPI: 1467419234
Provider Name (Legal Business Name): JUDITH ORRILL SHEA AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS JUDITH ANN ORRILL

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 12/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 HIGHLAND AVE SUITE 2
CHESHIRE CT
06410-2563
US

IV. Provider business mailing address

415 HIGHLAND AVE SUITE 2
CHESHIRE CT
06410-2563
US

V. Phone/Fax

Practice location:
  • Phone: 203-272-4512
  • Fax: 203-272-4517
Mailing address:
  • Phone: 203-272-4512
  • Fax: 203-272-4517

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number000152
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number000707
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number000152
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: