Healthcare Provider Details

I. General information

NPI: 1033160346
Provider Name (Legal Business Name): TIMOTHY JOHN SHEA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 01/07/2022
Certification Date: 03/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1409 ASHEVILLE HWY
BREVARD NC
28712-9524
US

IV. Provider business mailing address

PO BOX 602373
CHARLOTTE NC
28260-2373
US

V. Phone/Fax

Practice location:
  • Phone: 828-435-8400
  • Fax: 828-435-8401
Mailing address:
  • Phone: 828-213-1500
  • Fax: 828-651-6570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number9800693
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: