Provider Demographics
NPI:1932817228
Name:WESLEY, SHEA FEARNEYHOUGH (NP)
Entity type:Individual
Prefix:MRS
First Name:SHEA
Middle Name:FEARNEYHOUGH
Last Name:WESLEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:SHEA
Other - Middle Name:
Other - Last Name:FEARNEYHOUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1331 4TH ST SE APT 435
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20003-4466
Mailing Address - Country:US
Mailing Address - Phone:502-548-4749
Mailing Address - Fax:
Practice Address - Street 1:9256 BENDIX RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-1840
Practice Address - Country:US
Practice Address - Phone:443-542-0505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-07
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCNP1055896363L00000X
MDR261659363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner