Provider Demographics
NPI:1518913805
Name:SHIELDS RADIOLOGY ASSOCIATES
Entity Type:Organization
Organization Name:SHIELDS RADIOLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:T
Authorized Official - Last Name:SWERIDUK
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:800-258-4674
Mailing Address - Street 1:55 CHRISTY DR
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-1813
Mailing Address - Country:US
Mailing Address - Phone:800-258-4674
Mailing Address - Fax:508-897-1599
Practice Address - Street 1:313 SPEEN ST
Practice Address - Street 2:
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-1538
Practice Address - Country:US
Practice Address - Phone:844-258-4355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9786929Medicaid
MA9786929Medicaid