Provider Demographics
NPI:1083378020
Name:SHIELD INNOVATIONS INC
Entity Type:Organization
Organization Name:SHIELD INNOVATIONS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ED
Authorized Official - Middle Name:
Authorized Official - Last Name:MAURO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-470-4752
Mailing Address - Street 1:2151 DIAMOND CT
Mailing Address - Street 2:
Mailing Address - City:OLDSMAR
Mailing Address - State:FL
Mailing Address - Zip Code:34677-1948
Mailing Address - Country:US
Mailing Address - Phone:172-470-4752
Mailing Address - Fax:
Practice Address - Street 1:107 PINCKNEY ST
Practice Address - Street 2:
Practice Address - City:OLDSMAR
Practice Address - State:FL
Practice Address - Zip Code:34677-3142
Practice Address - Country:US
Practice Address - Phone:727-518-9773
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-26
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies