Provider Demographics
NPI:1114214202
Name:SHIELDS, SARAH-KIM (MD)
Entity Type:Individual
Prefix:
First Name:SARAH-KIM
Middle Name:
Last Name:SHIELDS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:593 EDDY ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-4923
Mailing Address - Country:US
Mailing Address - Phone:401-444-2133
Mailing Address - Fax:401-444-5017
Practice Address - Street 1:593 EDDY ST
Practice Address - Street 2:RADIOLOGY
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-4923
Practice Address - Country:US
Practice Address - Phone:401-444-2133
Practice Address - Fax:401-444-5017
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-08
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2772192085R0202X
RI152542085R0202X
MI1742220208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice