Healthcare Provider Details

I. General information

NPI: 1639128416
Provider Name (Legal Business Name): ROGER MARKS SHEA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 09/17/2020
Certification Date: 09/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5432 BEE RIDGE RD STE # 140
SARASOTA FL
34233
US

IV. Provider business mailing address

5432 BEE RIDGE RD STE # 140
SARASOTA FL
34233
US

V. Phone/Fax

Practice location:
  • Phone: 941-371-2244
  • Fax: 941-371-1144
Mailing address:
  • Phone: 941-371-2244
  • Fax: 941-371-1144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License NumberME0065243
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberME0065243
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: