Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 029051 | CT |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 029051 | CT |
NPI | 1225035694 |
---|---|
Provider Name | Kevin P. Shea |
First Address | Farmington, CT 06030-0001 |
Second Address | Farmington, CT 06030-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2005 |
Last Update Date | 19/04/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1290519 | (05) | CT |
D03022 | (02) | CT |