Provider Demographics
NPI:1376595546
Name:SHIELDS, CHERYL P (NP)
Entity Type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:P
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 1:907 E MICHIGAN ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-3625
Mailing Address - Country:US
Mailing Address - Phone:317-262-0950
Mailing Address - Fax:317-267-0244
Practice Address - Street 1:907 E MICHIGAN ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-3625
Practice Address - Country:US
Practice Address - Phone:317-262-0950
Practice Address - Fax:317-267-0244
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001537A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP86654Medicare UPIN
IN237490CMedicare PIN