Nicholas Joseph Shea, M.D.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

036123263 Issued in IL

Practice address

2045 W Grand Ave Ste B
PMB 82557
Chicago, IL 60612-1577

Phone

(312) 268-4070

Fax

(312) 277-1042

NPI assigned

Aug 22, 2008

Last updated

Apr 9, 2021By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Nicholas Shea PC

  • Psychiatry Physician
  • Chicago, IL
  • NPI 1285984047
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1219363200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617926400000",
    "number": "1942457882",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2045 W GRAND AVE STE B",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606121577",
            "telephone_number": "312-268-4070",
            "fax_number": "312-277-1042"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2045 W GRAND AVE STE B",
            "address_2": "PMB 82557",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606121577",
            "telephone_number": "312-268-4070",
            "fax_number": "312-277-1042"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHEA",
        "first_name": "NICHOLAS",
        "middle_name": "JOSEPH",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-08-22",
        "last_updated": "2021-04-09",
        "certification_date": "2021-03-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "IL",
            "license": "036123263",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036123263",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN (GROUP)",
            "identifier": "206147",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN (INDIVIDUAL)",
            "identifier": "206147027",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Connor Joseph Shea
• Dennis Shea, PA
• Emily Valentina Shea, MS
• Laura McGarry Shea, DPM
• Melanie Shea, PA-C
• Sheade Psychotherapy PLLC
• Allison Kupferberg Sheade, MA, LCPC
• Amanda Sheaffer Sheaffer
• John Newcomb Sheagren, M.D.
• Catherine M Sheahan, M.S. CCC-SLP

• Psychiatry Physician in Chicago, IL
• Providers in Chicago, IL by specialty
• Psychiatry Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.