Provider Demographics
NPI:1477917615
Name:SHIELS, MOIRA (MS)
Entity Type:Individual
Prefix:
First Name:MOIRA
Middle Name:
Last Name:SHIELS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6836 HEATHERWAY CT
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22315-3942
Mailing Address - Country:US
Mailing Address - Phone:614-578-8864
Mailing Address - Fax:
Practice Address - Street 1:10339A DEMOCRACY LN
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-2521
Practice Address - Country:US
Practice Address - Phone:703-591-3377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-13
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist