Provider Demographics
NPI:1407129810
Name:SHIELD, SONNY (MHPP)
Entity Type:Individual
Prefix:
First Name:SONNY
Middle Name:
Last Name:SHIELD
Suffix:
Gender:M
Credentials:MHPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 N SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-7704
Mailing Address - Country:US
Mailing Address - Phone:501-268-2812
Mailing Address - Fax:504-268-2824
Practice Address - Street 1:311 N SPRUCE ST
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-7704
Practice Address - Country:US
Practice Address - Phone:501-268-2812
Practice Address - Fax:504-268-2824
Is Sole Proprietor?:No
Enumeration Date:2012-02-15
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator