Provider Demographics
NPI:1285984047
Name:NICHOLAS SHEA PC
Entity type:Organization
Organization Name:NICHOLAS SHEA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, NICHOLAS SHEA, PC & PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:SHEA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-268-4070
Mailing Address - Street 1:180 N MICHIGAN AVE
Mailing Address - Street 2:SUITE 350
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-7401
Mailing Address - Country:US
Mailing Address - Phone:312-268-4070
Mailing Address - Fax:312-423-6695
Practice Address - Street 1:2045 W GRAND AVE STE B
Practice Address - Street 2:PMB 82557
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-1577
Practice Address - Country:US
Practice Address - Phone:312-268-4070
Practice Address - Fax:312-277-1042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-19
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361232632084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1942457882OtherINDIVIDUAL NPI NUMBER