Provider Demographics
NPI:1386647238
Name:SHIELDS, DENA B (RD)
Entity Type:Individual
Prefix:
First Name:DENA
Middle Name:B
Last Name:SHIELDS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 ROUTE 101
Mailing Address - Street 2:STE 10
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-5031
Mailing Address - Country:US
Mailing Address - Phone:603-472-2846
Mailing Address - Fax:603-472-2872
Practice Address - Street 1:360 ROUTE 101
Practice Address - Street 2:STE 10
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110-5031
Practice Address - Country:US
Practice Address - Phone:603-472-2846
Practice Address - Fax:603-472-2872
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH401133V00000X
MA2261133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX87P192Medicare ID - Type Unspecified