MEDICARE: JOSEPH B MCSHEA 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	207Q00000X	Family Medicine Physician	200600315	NC
2	207Q00000X	Family Medicine Physician	1304	SC

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972503332
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH B MCSHEA DO

Provider Business Mailing Address
First Line	:	955 RIBAUT RD
Second Line	:
City	:	BEAUFORT
State	:	SC
Zip	:	29902-5441
Country	:	US
Telephone Number	:	843-522-7843
Fax Number	:	843-522-5945

Provider Business Practice Location Address
First Line	:	122 OKATIE CENTER BLVD N STE 100
Second Line	:
City	:	OKATIE
State	:	SC
Zip	:	29909-3782
Country	:	US
Telephone Number	:	843-706-8840
Fax Number	:	833-314-0430

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

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	06/30/2021

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