Provider Demographics
NPI:1427684638
Name:SHEA, ROBERT THOMAS
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:THOMAS
Last Name:SHEA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:187 COLUMBIA TPKE
Mailing Address - Street 2:
Mailing Address - City:FLORHAM PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07932-1313
Mailing Address - Country:US
Mailing Address - Phone:973-755-9813
Mailing Address - Fax:
Practice Address - Street 1:187 COLUMBIA TPKE
Practice Address - Street 2:
Practice Address - City:FLORHAM PARK
Practice Address - State:NJ
Practice Address - Zip Code:07932-1313
Practice Address - Country:US
Practice Address - Phone:973-755-9813
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-19
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MG00138300237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist