Provider Demographics
NPI:1093062960
Name:SHIELDS, CHRISTOPHER J (PA-C)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:J
Last Name:SHIELDS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:575 TURNPIKE ST STE 11
Mailing Address - Street 2:
Mailing Address - City:NORTH ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845-5937
Mailing Address - Country:US
Mailing Address - Phone:978-794-1946
Mailing Address - Fax:
Practice Address - Street 1:16 PELHAM RD
Practice Address - Street 2:STE 1
Practice Address - City:SALEM
Practice Address - State:NH
Practice Address - Zip Code:03079-2826
Practice Address - Country:US
Practice Address - Phone:603-898-2244
Practice Address - Fax:603-898-2227
Is Sole Proprietor?:No
Enumeration Date:2012-08-10
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA4460363AS0400X
NH0911363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical