Provider Demographics
NPI:1285527788
Name:SHEA, SIMON PETER
Entity type:Individual
Prefix:
First Name:SIMON
Middle Name:PETER
Last Name:SHEA
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3005 SW BARTON ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98126-3913
Mailing Address - Country:US
Mailing Address - Phone:646-831-4988
Mailing Address - Fax:
Practice Address - Street 1:6112 GOULD AVE S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98108-2959
Practice Address - Country:US
Practice Address - Phone:202-780-6475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-02
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician