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NPI Code Detail

MEDICARE: SHEA KATHLEEN O'BRIEN MD

MEDICARE: SHEA KATHLEEN O'BRIEN MD
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
1207V00000XObstetrics & Gynecology PhysicianME151059FL
2390200000XStudent in an Organized Health Care Education/Training ProgramTRN25522FL

Other Identifiers

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

General Provider Information

NPI Number : 1275054231
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHEA KATHLEEN O'BRIEN MD
Provider Business Mailing Address
First Line : PO BOX 748817
Second Line :
City : ATLANTA
State : GA
Zip : 30374-8817
Country : US
Telephone Number : 813-286-0033
Fax Number : 813-282-1806
Provider Business Practice Location Address
First Line : 400 COLONNADE DR STE 230
Second Line :
City : PONTE VEDRA
State : FL
Zip : 32081-6237
Country : US
Telephone Number : 904-640-8249
Fax Number : 904-640-8250
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/29/2017
Last Update Date : 05/21/2026

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