Provider Demographics
NPI:1497564249
Name:SHEA, MAEVE (IBCLC)
Entity type:Individual
Prefix:
First Name:MAEVE
Middle Name:
Last Name:SHEA
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 GRANITE ST APT 4
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-2833
Mailing Address - Country:US
Mailing Address - Phone:781-264-7394
Mailing Address - Fax:
Practice Address - Street 1:25 GRANITE ST APT 4
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-2833
Practice Address - Country:US
Practice Address - Phone:781-264-7394
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-06
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEL-317152174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN