MEDICARE: DR. KATHLEEN SHEA PH.D.

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	103TS0200X	School Psychologist	SS1134	FL

General Provider Information

NPI Number	:	1053701888
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATHLEEN SHEA PH.D.

Provider Business Mailing Address
First Line	:	2706 ALT 19N, SUITE 214
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34683-2641
Country	:	US
Telephone Number	:	727-786-0600
Fax Number	:

Provider Business Practice Location Address
First Line	:	2706 ALT 19N, SUITE 214
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34683-2641
Country	:	US
Telephone Number	:	727-786-0600
Fax Number	:

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

Provider Enumeration Date	:	02/02/2015
Last Update Date	:	02/02/2015

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