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General NPI Number Information
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NPI Number | 1104762905
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Entity Type | Individual
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Provider Name | SHEA SERA
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Gender | Female
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Dates
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Enumeration Date | 04/25/2026
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Last Update Date | 04/25/2026
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Provider Practice Location Address
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Address Line | 2570 BLACKMON DR STE 310
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City | DECATUR
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State | GA
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Zip | 30033-6197
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Country | US
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Telephone | 678-203-3462
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 5006
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City | KAHULUI
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State | HI
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Zip | 96733-5006
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Country | US
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Telephone | 808-281-5943
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State | GA
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