Healthcare Provider Details

I. General information

NPI: 1497901201
Provider Name (Legal Business Name): ELIZABETH MARIA O'SHEA M.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2008
Last Update Date: 08/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 STATE ROUTE 17M
MONROE NY
10950-3455
US

IV. Provider business mailing address

520 STATE ROUTE 17M
MONROE NY
10950-3455
US

V. Phone/Fax

Practice location:
  • Phone: 845-782-0295
  • Fax: 845-782-5164
Mailing address:
  • Phone: 845-782-0295
  • Fax: 845-782-5164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: