Healthcare Provider Details

I. General information

NPI: 1518590793
Provider Name (Legal Business Name): SHEA DINEEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2020
Last Update Date: 02/17/2020
Certification Date: 02/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 W 47TH ST
NORFOLK VA
23529-0001
US

IV. Provider business mailing address

1015 W 47TH STREET
NORFOLK VA
23508
US

V. Phone/Fax

Practice location:
  • Phone: 757-683-7041
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: