Provider Demographics
NPI:1043555618
Name:SHIELDS, MEREDITH GROFF (NP)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:GROFF
Last Name:SHIELDS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:161 FORT WASHINGTON AVE
Mailing Address - Street 2:11TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-3729
Mailing Address - Country:US
Mailing Address - Phone:212-305-0114
Mailing Address - Fax:212-305-0116
Practice Address - Street 1:161 FORT WASHINGTON AVE
Practice Address - Street 2:11TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3729
Practice Address - Country:US
Practice Address - Phone:212-305-0114
Practice Address - Fax:212-305-0116
Is Sole Proprietor?:No
Enumeration Date:2012-12-07
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY306338363LA2200X, 363LA2200X
390200000X
NY643201163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03643529Medicaid
NYA400092205Medicare PIN