MEDICARE: DR. STEPHEN MICHAEL SHEA M.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	2084P0800X	Psychiatry Physician	A38102	CA

General Provider Information

NPI Number	:	1902994544
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN MICHAEL SHEA M.D.

Provider Business Mailing Address
First Line	:	1330 N HARPER AVE APT 207
Second Line	:
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90046-3704
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1975 LONG BEACH BLVD
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90806-5501
Country	:	US
Telephone Number	:	562-218-4026
Fax Number	:	562-599-3934

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

Provider Enumeration Date	:	10/10/2006
Last Update Date	:	07/08/2007

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