Provider Demographics
NPI:1073237269
Name:SHIELDS, INDIA M
Entity Type:Individual
Prefix:
First Name:INDIA
Middle Name:M
Last Name:SHIELDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2611 RICHMOND HWY STE 700
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23234-1125
Mailing Address - Country:US
Mailing Address - Phone:844-381-4432
Mailing Address - Fax:877-763-2165
Practice Address - Street 1:248 14TH PL NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-6408
Practice Address - Country:US
Practice Address - Phone:202-365-5744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-30
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide