MEDICARE: DR. GERALDINE TERESE O'SHEA DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	20A7363	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013910140
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GERALDINE TERESE O'SHEA DO

Provider Business Mailing Address
First Line	:	235 NEW YORK RANCH RD
Second Line	:	STE B
City	:	JACKSON
State	:	CA
Zip	:	95642-2147
Country	:	US
Telephone Number	:	209-257-1057
Fax Number	:	209-257-1058

Provider Business Practice Location Address
First Line	:	235 NEW YORK RANCH RD
Second Line	:	STE B
City	:	JACKSON
State	:	CA
Zip	:	95642-2147
Country	:	US
Telephone Number	:	209-257-1057
Fax Number	:	209-257-1058

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	03/05/2008

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