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NPI Profile for JACLYN K SHEA in MEDFORD, NY.
Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Family |
363LF0000X | 50 | Nurse Practitioner |
| NPI Number | 1861168411 |
|
| Status | Active | |
| Credentials | ||
| Entity | Individual | |
| Enumeration date | 08/23/2021 | |
| Last updated | 03/10/2022 - About 4 years ago | |
| Sole proprietor 1 | Yes | |
| Identifiers |
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| Hospital affiliation(s) |
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JACLYN K SHEA
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JACLYN K SHEA