Provider Demographics
NPI:1306964580
Name:SHEA, VIRGINIA ROSE (APRN)
Entity type:Individual
Prefix:MRS
First Name:VIRGINIA
Middle Name:ROSE
Last Name:SHEA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 POMFRET ST
Mailing Address - Street 2:
Mailing Address - City:PUTNAM
Mailing Address - State:CT
Mailing Address - Zip Code:06260-1836
Mailing Address - Country:US
Mailing Address - Phone:860-779-9270
Mailing Address - Fax:860-779-7597
Practice Address - Street 1:346 POMFRET ST
Practice Address - Street 2:
Practice Address - City:PUTNAM
Practice Address - State:CT
Practice Address - Zip Code:06260-1871
Practice Address - Country:US
Practice Address - Phone:860-928-4344
Practice Address - Fax:860-928-4188
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003084363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care