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General NPI Number Information
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NPI Number | 1629404520
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Entity Type | Individual
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Provider Name | CATHERINE THERESA SHEA RN
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Gender | Female
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Dates
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Enumeration Date | 09/24/2013
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Last Update Date | 09/24/2013
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Provider Practice Location Address
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Address Line | 570 4TH ST
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City | RONKONKOMA
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State | NY
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Zip | 11779-6426
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Country | US
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Telephone | 516-236-8897
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Fax |
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Provider Business Mailing Address
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Address Line | 570 4TH ST.
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City | RONKONKOMA
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State | NY
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Zip | 11779
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Country | US
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Telephone | 516-236-8897
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number | 426008
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 426008
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License Number State | NY
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