Healthcare Provider Details

I. General information

NPI: 1215222377
Provider Name (Legal Business Name): NEIL SHEA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2011
Last Update Date: 01/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 N GEORGE MASON DR STE 355
ARLINGTON VA
22205-3690
US

IV. Provider business mailing address

7 SAINT ALFRED ROAD
ST. LOUIS MO
63132
US

V. Phone/Fax

Practice location:
  • Phone: 703-521-6662
  • Fax: 703-521-5991
Mailing address:
  • Phone: 314-265-7278
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number125059627
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number0101261771
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: