Provider Demographics
NPI:1386388163
Name:VERDOUX, SHEA LYNN (RRT)
Entity type:Individual
Prefix:
First Name:SHEA
Middle Name:LYNN
Last Name:VERDOUX
Suffix:
Gender:F
Credentials:RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9625 SAINT JOSEPH ST
Mailing Address - Street 2:
Mailing Address - City:LEO
Mailing Address - State:IN
Mailing Address - Zip Code:46765-9655
Mailing Address - Country:US
Mailing Address - Phone:989-277-8187
Mailing Address - Fax:
Practice Address - Street 1:9625 SAINT JOSEPH ST
Practice Address - Street 2:
Practice Address - City:LEO
Practice Address - State:IN
Practice Address - Zip Code:46765-9655
Practice Address - Country:US
Practice Address - Phone:989-277-8187
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-26
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN30010184A227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered