Provider Demographics
NPI:1548447170
Name:SHEA, CANDICE ELLEN (MD)
Entity type:Individual
Prefix:
First Name:CANDICE
Middle Name:ELLEN
Last Name:SHEA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1131 WEST ST
Mailing Address - Street 2:BUILDING 2
Mailing Address - City:SOUTHINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06489-6006
Mailing Address - Country:US
Mailing Address - Phone:860-276-6800
Mailing Address - Fax:860-276-6801
Practice Address - Street 1:1131 WEST ST
Practice Address - Street 2:BUILDING 2
Practice Address - City:SOUTHINGTON
Practice Address - State:CT
Practice Address - Zip Code:06489-6006
Practice Address - Country:US
Practice Address - Phone:860-276-6800
Practice Address - Fax:860-276-6801
Is Sole Proprietor?:No
Enumeration Date:2008-01-25
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001836207V00000X
CT48592207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology