Healthcare Provider Details

I. General information

NPI: 1659530178
Provider Name (Legal Business Name): MICHAEL LEIGH SHEA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2008
Last Update Date: 04/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1113 S STATE ST SUITE 100
DOVER DE
19901-4112
US

IV. Provider business mailing address

1113 S STATE ST SUITE 100
DOVER DE
19901-4112
US

V. Phone/Fax

Practice location:
  • Phone: 302-734-7676
  • Fax: 302-734-7615
Mailing address:
  • Phone: 302-734-7676
  • Fax: 302-734-7615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number244549
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberC1-0009461
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: