Provider Demographics
NPI:1164017992
Name:SHEA, KAYLA
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:SHEA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 WINFIELD RD
Mailing Address - Street 2:
Mailing Address - City:HOLDEN
Mailing Address - State:MA
Mailing Address - Zip Code:01520-2442
Mailing Address - Country:US
Mailing Address - Phone:857-540-7470
Mailing Address - Fax:
Practice Address - Street 1:34 CHARLES DR
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MA
Practice Address - Zip Code:02021-1543
Practice Address - Country:US
Practice Address - Phone:857-228-5757
Practice Address - Fax:617-396-3077
Is Sole Proprietor?:No
Enumeration Date:2021-03-03
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor