Provider Demographics
NPI:1588463251
Name:SHEA, CASSANDRA LEA
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:LEA
Last Name:SHEA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2242 S 84TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-2225
Mailing Address - Country:US
Mailing Address - Phone:402-319-5499
Mailing Address - Fax:
Practice Address - Street 1:2242 S 84TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-2225
Practice Address - Country:US
Practice Address - Phone:402-319-5499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-13
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEH12132405171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor