Provider Demographics
NPI:1154960813
Name:SHEA, DENNIS (PA)
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:
Last Name:SHEA
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 E ONTARIO ST STE 200
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-3284
Mailing Address - Country:US
Mailing Address - Phone:312-694-7000
Mailing Address - Fax:312-926-6274
Practice Address - Street 1:211 E ONTARIO ST STE 200
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-3284
Practice Address - Country:US
Practice Address - Phone:312-694-7000
Practice Address - Fax:312-926-6274
Is Sole Proprietor?:No
Enumeration Date:2019-12-29
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363AS0400X
IL085008502363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical