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General NPI Number Information
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NPI Number | 1316932791
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Entity Type | Individual
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Provider Name | WILLIAM EDWIN SHEA PA-C
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Gender | Male
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Dates
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Enumeration Date | 09/13/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 365 MONTAUK AVE LAWRENCE AND MEMORIAL HOSPITAL
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City | NEW LONDON
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State | CT
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Zip | 06320-4700
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Country | US
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Telephone | 860-441-0711
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Fax |
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Provider Business Mailing Address
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Address Line | 3 MEADOW DR
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City | GALES FERRY
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State | CT
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Zip | 06335-1815
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Country | US
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Telephone | 860-464-4013
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 001306
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License Number State | CT
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