Provider Information for 1225035694
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KEVIN P. SHEA MD
Sex: Male
NPI: 1225035694
Last Updated: 2022-09-12
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1225035694 | ||||||||||||||
| Enumeration Date | 2005-06-30 | ||||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||||
| Sole Proprietor | NO | ||||||||||||||
| Status | Active | ||||||||||||||
| Mailing Address | UCONN MEDICAL GROUP 263 FARMINGTON AVE FARMINGTON, CT 06030-0001 United States Phone: 860-679-6600 | Fax:860-679-6649 | ||||||||||||||
| Primary Practice Address | UCONN MEDICAL GROUP 263 FARMINGTON AVE FARMINGTON, CT 06030-0001 United States Phone: 860-679-6600 | Fax:860-679-6649 | ||||||||||||||
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