Provider Demographics
NPI:1902176878
Name:SHEA, ROBERT A (DMD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:A
Last Name:SHEA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 W NECK RD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-2458
Mailing Address - Country:US
Mailing Address - Phone:631-421-2205
Mailing Address - Fax:
Practice Address - Street 1:241 W NECK RD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-2458
Practice Address - Country:US
Practice Address - Phone:631-421-2205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-09
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038426122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist