Provider Demographics
NPI:1578677985
Name:SHIELDS-SZABO, TERESA E (MD)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:E
Last Name:SHIELDS-SZABO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:TERESA
Other - Middle Name:E
Other - Last Name:SHIELDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:26795 PORTOLA PKWY
Mailing Address - Street 2:
Mailing Address - City:FOOTHILL RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:92610-1713
Mailing Address - Country:US
Mailing Address - Phone:949-829-9403
Mailing Address - Fax:949-829-9422
Practice Address - Street 1:26795 PORTOLA PKWY
Practice Address - Street 2:
Practice Address - City:FOOTHILL RANCH
Practice Address - State:CA
Practice Address - Zip Code:92610-1713
Practice Address - Country:US
Practice Address - Phone:949-829-9403
Practice Address - Fax:949-829-9422
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO39601207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO39601OtherSTATE BOARD
CO39601OtherSTATE BOARD
C89488Medicare UPIN