MEDICARE: MR. NICHOLAS JOHN SHEA MD, MS

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	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	295509	NY
2	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	79300	CT
3	208600000X	Surgery Physician	295509	NY

General Provider Information

NPI Number	:	1790149086
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. NICHOLAS JOHN SHEA MD, MS

Provider Business Mailing Address
First Line	:	1 HOSPITAL PLZ FL 2
Second Line	:
City	:	STAMFORD
State	:	CT
Zip	:	06902-3602
Country	:	US
Telephone Number	:	203-276-4440
Fax Number	:	203-276-4401

Provider Business Practice Location Address
First Line	:	1 HOSPITAL PLZ FL 2
Second Line	:
City	:	STAMFORD
State	:	CT
Zip	:	06902-3602
Country	:	US
Telephone Number	:	203-276-4440
Fax Number	:	203-276-4401

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

Provider Enumeration Date	:	04/12/2016
Last Update Date	:	02/11/2026

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