Healthcare Provider Details

I. General information

NPI: 1033609128
Provider Name (Legal Business Name): EMILY M SHEA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2018
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8605 CENTREVILLE RD
MANASSAS VA
20110-5265
US

IV. Provider business mailing address

6209 RIDGE POND RD APT B
CENTREVILLE VA
20121-4094
US

V. Phone/Fax

Practice location:
  • Phone: 703-257-0935
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number0119-007689
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: